Funeral Arrangement Worksheet
Fill out the form carefully and verify all information is correct.
Deceased Information
Name
*
First Name
Middle Name
Last Name
Suffix
Nickname
Date of Birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Date of Death
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Time of Death
Hour Minutes
AM
PM
AM/PM Option
Age
Sex
Please Select
Male
Female
N/A
Social Security Number
Marital Status
Please Select
Married
Single
Divorced
Widowed
Place of Death
Facility (If Applicable) and Street Address
City
State / Province
Postal / Zip Code
County
Birthplace
State or Country (If not USA)
Deceased Residence
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Residence
Residence Inside City Limits?
Yes
No
US Citizen?
Yes
No
If Not a US Citizen, What Country?
Hispanic Origin?
Yes
No
Race
i.e. White, Black, Asian or Pacific Islander, American Indian, Latino, Puerto Rican, Cuban etc.
Served in Armed Forces?
Yes
No
DD214 Discharge Papers Available?
Yes
No
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)
Yes
No
Level of Education
Please Select
8th Grade or Less
9th - 12th Grade, No Diploma
High School Graduate or GED
Some College Credit, No Degree
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate or Professional Degree
Occupation
Business or Industry
Father's Full Name
First Name
Middle Name
Last Name
Suffix
Mother's Full Name
First Name
Middle Name
Maiden Last Name
Suffix
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
City
State / 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
Burial
Cremation
If Burial, Select Services (If Undecided, Leave Blank)
Visitation Service
Funeral Service
Graveside Service
If Cremation, Select Services (If Undecided, Leave Blank)
Direct Cremation (No Services)
Visitation Service
Memorial Service
Funeral Service
Graveside Service
Visitation Information
Visitation Location
i.e. Hilton Funeral Home, Name of Facility
Visitation Date
-
Month
-
Day
Year
Date
Visitation Time
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Funeral Service Information
Funeral Service Location
i.e. Hilton Funeral Home, Name of Facility
Funeral Service Date
-
Month
-
Day
Year
Date
Funeral Service Time
Hour Minutes
AM
PM
AM/PM Option
Casket (If Applicable):
Open
Closed
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
City
State / Province
Postal / Zip Code
Graveside Service Date
-
Month
-
Day
Year
Date
Graveside Service Time
Hour Minutes
AM
PM
AM/PM Option
Stone in Place?
Yes
No
Memorial Service Information
Memorial Service Location
i.e. Hilton Funeral Home, Name of Facility
Memorial Service Date
-
Month
-
Day
Year
Date
Memorial Service Time
Hour Minutes
AM
PM
AM/PM Option
Religion
Obituary Information
Would you like to have an obituary appear on our website or in a newspaper publication?
Yes
No
Will you submit your own or will you be needing help to write one?
I will write my own
I will need some guidance
Father's Full Name
First/Middle/Last
Father is
Surviving
Deceased
Mother's Full Name
First/Middle/Last
Mother is
Surviving
Deceased
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?
Yes
No
Submit
Should be Empty: