Mealey Funeral Homes | Preplanning

This form is provided as a service to allow you to record funeral preferences for yourself or a loved one. If you are not comfortable sending this information in an e-mail message, please feel free to contact us directly or print this page and deliver it to us.

Personal Information

I am planning for

Name: (First MI Last)
Sex:
Marital Status:
Date of Birth:
Place of Birth:

Address:
City:
County:
State:
Zip:
Phone:
E-mail:

Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Father's Name:
Mother's Name:
Mother's Maiden Name:

Work/Education Information

Education Level:	Primary Secondary
Occupation:
Business:
Industry:
Company:
Number of Years:

Military Service

Service Branch:
Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge On File At:
Name of Wars:

Funeral Preferences

I Prefer:
I Prefer My Funeral Service To Be
Place of Service:
Religious Denomination:
Place of Worship:
Person Officiating Service:	Name:

Memorialization Instructions

Musical Selection to Be Played:

I will supply CD/Tape

Musical Selections to Be Sung:
1.
2.
3.
4.
Readings:
Favorite Flower(s):
Favorite Flower Color:

Final Disposition

Preference for Final Disposition is:
Ground Interment with burial container
Mausoleum Entombment
Cremation with
Preference for cemetery or Mausoleum is:
Address:
A is owned at the above location

Special Instructions

Person to Finalize Arrangement at Time of Death

Name:
Relationship:
Address:
City:
State:
Zip:
Phone:
E-mail: