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PRE-PLAN YOUR FUNERAL

Thank you for choosing to submit the following information for pre-planning your funeral arrangements. If you would like to speak to a funeral director at any time, or have questions in regards to the pre-arrangement process or this document, please feel free to contact us at 705-335-2433.

Information About Person Completing This Form

TODAY'S DATE:
FIRST NAME:
MIDDLE INITIAL:
LAST NAME:

I AM PLANNING FOR:
MYSELF   SPOUSE   MOTHER   FATHER   CHILD   FRIEND
OTHER

DAYTIME PHONE:
EVENING PHONE:
EMAIL ADDRESS:

Vital Statistics  

First Name:
Middle Name:
Last Name:
Maiden Name:

   Male       Female

Address:
City/Town:
Province:
Postal Code:
Phone:
Email Address:
Date of Birth:
Birthplace:
Father's Name
Father's Place of Birth:

Deceased:                   Yes      No

Mother's Name:
Mother's Place of Birth:

Deceased:                   Yes      No

Marital Status                                                                                                                  

Single   Married   Seperated   Divorced   Widowed   Common-law

Immediate Family

Names of Surviving Children:
Please list name, spouse's name and city/town.

Current Number of Grandchildren:
Current Number of Great-Grandchildren:

Names of Surviving Brothers and Sisters:
Please list name, spouse's name and city/town.

Names of Pre-Deceased Family Members:
Please list name and relationship.

Personal History

Occupation:
Name of Employer:
Last Position Held:
How Long:

If Retired, Date of Retirement:
Total Years Spent in Occupation:

Church Affiliations and Activities

Military
WWII      Korean      Vietnam      Other

Branch of Service:
Enlistment Date:
Rank at Discharge:
Discharge Date:
Enlistment Place:
Service Number:

Special Affiliations
Lodges, Memberships, Public Office, Fraternal Organizations (past and present)

Hobbies and Special Interests

Final Wishes

Traditional Funeral Service
Graveside Burial Service
Immediate Burial
Traditional Funeral Service (followed by cremation)
Memorial Cremation Service (with visitation)
Memorial Cremation Service (no visitation)
Graveside Cremation Service
Direct Cremation
 

Cemetery:
City:
Province:
Section:
Lot:
Space:

Marker Installed?           Yes        No 

My Special Wishes
Clothing, Jewellery, Music, etc...
 

Funeral Service

Funeral Home
Church 
Graveside
Rosary
Prayer Service

Other:
City:
Province:

Newspaper Obituary
The funeral home will notify the newspapers of your choice.

Photo in Obituary?      Yes      No

Authorized Person to Arrange Final Details

Name:
Address:
City/Town:
Province:
Postal Code:
Phone Number:
Alternate Name:
Address:
City/Town:
Province:
Postal Code:
Phone Number:

 
Thank you for taking the time to complete this information.

Please let us know how we can be of further assistance to you by choosing one of the following:

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