Funeral Arrangement Worksheet

Funeral Arrangement Worksheet

Fill out the form carefully and verify all information is correct.
Deceased Information
Name*

First NameMiddle NameLast NameSuffix
Nickname
Date of Birth

MonthDayYear
Date of Death

MonthDayYear
Time of Death

Hour Minutes

AM/PM Option
Age
Sex
Social Security Number
Marital Status
Place of Death

Facility (If Applicable) and Street Address

CityState / Province

Postal / Zip Code
County
Birthplace
State or Country (If not USA)
Deceased Residence

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence
Residence Inside City Limits?

YesNo
US Citizen?

YesNo
If Not a US Citizen, What Country?
Hispanic Origin?

YesNo
Race
i.e. White, Black, Asian or Pacific Islander, American Indian, Latino, Puerto Rican, Cuban etc.
Served in Armed Forces?

YesNo
DD214 Discharge Papers Available?

YesNo
Branch of Service (If Applicable)
(i.e. Army, Navy, Air Force, Marines, Coast Guard)
Would You Like a Military Burial Flag? (If DD214 is present)

YesNo
Level of Education
Occupation
Business or Industry
Father's Full Name

First NameMiddle NameLast NameSuffix
Mother's Full Name

First NameMiddle NameMaiden Last NameSuffix
Next of Kin Information
Next of Kin's Full Name
Next of Kin's Relationship to Deceased
Next of Kin's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Next of Kin's Email Address
example@example.com
Next of Kin's Phone Number
Please enter a valid phone number.
Service Information

Please fill in only the sections that apply. If undecided, leave blank.
Type of Disposition

BurialCremation
If Burial, Select Services (If Undecided, Leave Blank)

Visitation ServiceFuneral ServiceGraveside Service
If Cremation, Select Services (If Undecided, Leave Blank)

Direct Cremation (No Services)Visitation ServiceMemorial ServiceFuneral ServiceGraveside Service
Visitation Information
Visitation Location
i.e. Hilton Funeral Home, Name of Facility
Visitation Date

MonthDayYear
Date
Visitation Time

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Funeral Service Information
Funeral Service Location
i.e. Hilton Funeral Home, Name of Facility
Funeral Service Date

MonthDayYear
Date
Funeral Service Time

Hour Minutes

AM/PM Option
Casket (If Applicable):

OpenClosed
Officiant Name
Officiant Phone Number
Please enter a valid phone number.
Graveside Service Information
Graveside Service Location
i.e. Name of Cemetery
Cemetery Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Graveside Service Date

MonthDayYear
Date
Graveside Service Time

Hour Minutes

AM/PM Option
Stone in Place?

YesNo
Memorial Service Information
Memorial Service Location
i.e. Hilton Funeral Home, Name of Facility
Memorial Service Date

MonthDayYear
Date
Memorial Service Time

Hour Minutes

AM/PM Option
Religion
Obituary Information
Would you like to have an obituary appear on our website or in a newspaper publication?

YesNo
Will you submit your own or will you be needing help to write one?

I will write my ownI will need some guidance
Father's Full Name
First/Middle/Last
Father is

SurvivingDeceased
Mother's Full Name
First/Middle/Last
Mother is

SurvivingDeceased
Full Names of Children (add a new row for each child)
Full Names of Brothers/Sisters (add a new row for each sibling)
Others To Include in Obituary
Number of Grandchildren
Number of Great Grandchildren
Number of Great Great Grandchildren
List Any Clubs or Organizations to Include
In Lieu of Flowers, Send Donations To:
List All Newspapers You'd Like The Obituary Published, If Any
Will There Be a Photo Included in the Paper or on Our Website?

YesNo
Should be Empty:

Funeral Arrangement Worksheet

Deceased Information

Next of Kin Information

Service Information

Visitation Information

Funeral Service Information

Graveside Service Information

Memorial Service Information

Obituary Information