Pre-Planning Form

Please complete as much or as little of the form as you would like.

Personal Information
First Name:
Middle Name(s):
Last Name:
Telephone Number:
E-mail Address:



Address:
Town/City:
State:
Zip Code:
Date of Birth:
Place of Birth: (city&state or County & state)
Marital Status:
Spouses Name: (Maiden name and full name of wife or husband's full name)
Occupation: (for longest period during working life)
Social Security Number:
Father's Full Name:
Mother's Full Name: (include her maiden name)
Person who will be in charge of my funeral arrangements:
Name:
Address:
Town/City:
State:
Zip:
Telephone Number:
Military Information
Branch of Service:
Description of Service: (Wars fought in, medals earned, military campaigns)
Veteran's Service Number:
Rank:
Location of Discharge Papers:
Family Members
Spouse: (Address and phone numbers)
Daughters: (Hometowns and phone numbers)
Sons: (Hometowns and phone pumbers)
Grandchildren: (Hometowns and phone numbers)
Sisters: (Hometowns and phone numbers)
Brothers: (Hometowns and phone numbers)
Other Relatives: (List relation, hometowns, and phone numbers)
My Funeral Service Preferences
Place of Service: (Funeral Home, Church, Graveside, or other)
Clergy: (Minister's hometown and phone number)
Type of Disposition:	Burial Entombment Cremation Other(Describe Below)
Cemetery Property Owned?	Yes No
Name of Cemetery: (Include: Location of Cemetery, City, & State)
Cemetery Preference: (If property not owned, include location of cemetery, city & state)
Music Selections: (Organ or piano background, live vocal, or recorded music) (If live vocal, include the vocalist, and their phone number) (List of songs)
Pallbearers or Honorary Pallbearers: (Include pallbearers hometown, home phone number, and bearer type designation) (A = Active Bearer, H = Honorary Bearer)
Lodge, Society, Fraternal Organization: (List involvement and if you would like an honor guard)
Flowers:
Memorial Contributions / Donations:
Obituary Information: (List education and place of schooling, wedding date and place, work history and places I lived and worked, Clubs, Lodges, Hobbies, what I liked doing, significant accomplishments, Boards, Committees and community and Church involvement, etc.)
Any information or special instructions not previously listed:
Please check as many of the following as apply.
Please contact me so that I may select my casket and vault in advance.
Please forward me a copy of my information for my records.
Please contact me if any of my submitted information needs clarification.
File my information for future reference at Ritchie & Peach Funeral Home, but please do not contact me.
I would like to discuss my pre-payment options with no obligation, please contact me.

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