FUNERAL ARRANGEMENT WORKSHEET

Southview Mortuany, Inc. 2731 U.S. Highway 40 S. 305 North Elm St. 125 2ND Ave. S.W. Tifton, GA 31794 Adel, GA 31620 Moultrie, GA 31768 (229) 387-7046 (229) 896-1380 (229) 668-7046
FUNERAL ARRANGEMENT WORKSHEET
NO.
First Name
Middle Name
Last Name
AGE
DATE OF DEATH

MonthDayYear
Date
DEATH HOUR
Arrangement Appointment Day & Time
Address
Informant Interviewed by
VITAL STATISTICS
DECEDENT'S ADDRESS
City-Town
State/Zip
County
PLACE OF DEATH
City-Town
State/Zip
Country
Specify
Apparent Cause of Death
Length of Illness
Other Circumstances
Certifier of Death Certificate
Certifier's Address
Sex
Race Ethnicity
Citizen
BIRTHPLACE
DATE OF BIRTH

MonthDayYear
Date
Father's Name
His Birthplace
Mother's Maiden Name
Her Birthplace
Marital Status
Surviving Spouse
Date & Place of Marriage
Employment Status
Usual Occupation
Kind of Business
Employer
No. of Years
Social Security No.
Highest Education
Veteran
Branch of Service
Rank
Service Dates
Service No.
Honors Commendations
INFORMANT'S NAME
Informant's Address
Informant's Phone
Format: (000) 000-0000.
Relationship
VISITATION
Day
Hours
Day
Hours
Day
Hours
Casket Opened
ROOM
Special Setup
FUNERAL SERVICES
Day/Date
Hour
Place
Clergy
Music
Organist
Soloist
Family Will Sit in
No. of Reserved Seats
No. of Family Cars
Address
Pickup Time
Address
Pickup Time
When will casket be closed?
Jewelry, etc. to remove for family
Pallbearers
Commital Service
BIOGRAPHICAL INFORMATION
Length of time living in this area
Moved from
Religion
Church/Synagogue
City
Clubs, Organizations, Other Information
Preceded in Death by (Spouse's Name)
Year
SURVIVORS
Spouse
Parent(s)
Children
Sisters/Brothers
GrandChildren
Great GrandChildren
Great-Great GrandChildren
Other Survivors
Should be Empty:

FUNERAL ARRANGEMENT WORKSHEET

VITAL STATISTICS

VISITATION

FUNERAL SERVICES

BIOGRAPHICAL INFORMATION

SURVIVORS