Make these important decisions in the privacy of your own home with our simple online pre-planning form. Your Contact InformationI am planning for*MyselfSpouseParentChildSiblingGrandparentGrandchildRelativeFriendA Person I am POA forA Person I am Guardian forOtherYour Name* First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Phone NumberEmail* Gender Male Female Personal Information (person the preplanning is for)Name* First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code City of Birth* Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Male Female Race Caucasian Black Chinese Japanese Hispanic American Indian Other Other (Race) CitizenshipUnited StatesOtherApproximate Height* Approximate Weight* Marital StatusMarriedDivorcedWidowedNever MarriedMarried but SeparatedSpouse's Name (Maiden) Father's Name Mother's Name (Maiden) EducationElementary School - Enter number of years completed High School - Enter number of years completed or GED College - Enter number of years completed Degree / Major Work HistoryOccupation (prior to retirement)Prior JobHomemakerDisabledJob DescriptionMilitary ServiceHave you ever served in the Military? Yes No Branch of ServiceArmyAir ForceNavyMarinesCoast GuardDate EnlistedMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date DischargedMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Final Disposition We have no interest in trying to sell you services or merchandise you do not need or want, however, it is important for our staff to be aware of your plans in order to best meet your expectations. Please help us better meet your needs by answering the following:Private or Public ViewingPrior to cremation, is there to be any viewing by family or friends? If so, private or public?PrivatePublicMemorial ServiceIs there going to be any kind of memorial service or celebration of life? If so, what type of service and where? Receiving the CremainsWho is to receive the cremains following the cremation? If more than one person, please list the names of the appropriate parties. InterrmentAre the cremations to be interred in a cemetery lot or niche? If so, please indicate location. VeteransIf you are a veteran, do you wish to have a military service at the cemetery?YesNoScattering CremainsAre the cremations to be scattered? If so, where and by whom. Number of Certified Death Certificates RequestedCAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ