Funeral Pre-Planning

Pre-planning
Pre-planning or pre-arranging a funeral provides peace of mind for yourself, as well as your loved ones. Pre-planning helps to ease undue emotional and financial stress at the time of a death. Perhaps the most influential reason to think ahead is the assurance that your wishes will be known and respected.

Pre-planning at Horner, Lieske, McBride & Kuhl can be as simple as visiting with one of our knowledgeable professionals or as detailed as planning and funding a complete funeral. Our counselors can explain the different options available for funding pre-arrangements, including those options that allow funeral prices to be locked-in or guaranteed. Rest assured when you meet with a professional from Horner, Lieske, McBride & Kuhl, there are no high pressure sales tactics. Simply put, we’re here to help.

To get started, please complete as much of the information below as possible. The information requested on this form is used for death certificate information, newspaper obituaries and to fulfill family wishes. The “Personal Information,” “Work and Education History” and “Military Service” sections are often the most difficult information to obtain at the time funeral arrangements are being made. This information will be kept on file at Horner, Lieske, McBride & Kuhl and can be provided to your family when needed.

I am planning for:

Personal Information

Full Name (First Middle Last):*

Gender:

Marital Status:

Date of Birth (mm/dd/yyyy):*

Place of Birth:*

Address:

City:

Country:

State:

Zip:

Phone:

E-Mail:

Spouse's Name:

Spouse's Maiden Name:

Place of Marriage:

Date of Marriage (mm/dd/yyyy):

Father's Name:

Mother's Name:

Mother's Maiden Name:

Employment / Education History

Education Level - Primary:

Education Level - Secondary:

Occupation:

Business:

Industry:

Company:

# of Years:

Military Service

Service Branch:

Date Enlisted (mm/dd/yyyy):

Date Discharged (mm/dd/yyyy):

Rank at Discharge:

Discharge on File At:

Conflicts Served In:

Funeral Preferences

I Prefer My Funeral Service to Be:

Place of Service:

Conclude Service At:

Religious Denomination:

Place of Worship:

Name:

Memorialization Instructions

Musical Selection to be Played:

Will Supply CD/Tape:

Musical Selection to be Sung:

Favorite Bible Passages:

Favorite Literature or Poems:

Favorite Flower(s):

Favorite Flower Color:

Final Disposition

Preference for Final Disposition:

Ground Interment
Mausoleum Entombment
Cremation

Preference of Cemetery or Mausoleum Is:

Address:

Please select what is owned at above location:

Special Instructions

Special Instructions:

Person to Finalize Arrangements at Time of Death

Name:

Relationship:

Address:

City:

Country:

State:

Zip:

Phone:

E-Mail:

What would you like us to do with your information:

Send me information on pre-arrangement.
Contact me to set an appointment.
Keep my information on file.