Pre Planning Form

This document is presented as a guide to the information requested by your funeral director when arranging an at need or prearranged funeral.

It is particularly useful when making arrangements to have a funeral in Scranton while living out of the area.  There is quite a bit of statistical information needed when someone passes away and it can be much easier on family members to have it in place ahead of time.  It also helps to prevent costly mistakes from being made on paperwork that will be filed with several local, state and federal organizations.

Should you decide to submit this information to us we will keep this form on file until such time as it's needed.  If you would rather not send this information the form can be printed, filled in and kept until needed.  It will give you an idea of what will be needed and what decisions need to be made.

Not all the fields are required to be filled out. This form should be printed and kept with your other important papers.

All fields marked with an * are required:

Biographical Information
Planning guide is for	MyselfSpouseMotherFatherChildFriendOther
Full Name*
Email Address*
Telephone Number including Area Code
Address:
Street 1
Street 2
City
State
Zip Code
Resident Since
Citizen of Country
Place of Birth:
City of Birth
County of Birth
State of Birth
Zip of Birth
Social Security Number
Parents:
Father
Mother Maiden Name
Family:
Marital Status	MarriedSingleSeparatedDivorcedWidowed
Spouse Maiden Name
Children Name Address Phone
Work History:
Occupation
Employed by
Retirement Date
Education:
Elementary
High School
College
Military Service:
Branch
Rank
Date of Enlistment
Date of Discharge
Location of Discharge
Serial Number
Funeral Preferences:
Type of Service	PublicPrivateNot Sure
Visitation	YesNoNot Sure
Place of Service	Funeral HomeChurchOther
Conclude Service at	Funeral HomeGrave SideChurchReception HallOther
Religious Denomination
Place of Worship
Type of Clergy
Type of Interment	BurialCremationEntombment
Casket Type	WoodSteelCopperBronzeCremation UrnCardboard
Final Disposition:
Final Disposition	BurialNiche EntombmentHome MemorializationScattering
Cemetery Name
Cemetery Address
Finalizing Arrangements:
Do you have a will	YesNoNot Sure
Lawyers Name
Executors Name
Executors Address
Executors Phone Number
Executors Email Address
Relationship to you
Relatives and Friends to Notify:
Relatives and Friends to Notify
Memberships
Additional Survivors
Contributions
Your Sex
Your Race
Age
Hispanic Origin	YesNo
Physician
Physician Address
Informant Name
Relationship
Informant Address
Informant City
Informant State
Informant Zip
Informant Phone
Flower Preference
Casket Bearers
Special Instructions
Other Instructions
Notes
Would You Like Us to Contact You	YesNo
How	US MailE-MailTelephone

 

                      

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Copyright © 2005 Miller Bean Funeral Home, Inc.
Last modified: Thursday, March 24, 2005