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?
US Citizen?
If Not a US Citizen, What Country?
Hispanic Origin?
Race
i.e. White, Black, Asian or Pacific Islander, American Indian, Latino, Puerto Rican, Cuban etc.
Served in Armed Forces?
DD214 Discharge Papers Available?
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)
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.Format: (000) 000-0000.
Service Information

Please fill in only the sections that apply. If undecided, leave blank.
Type of Disposition
If Burial, Select Services (If Undecided, Leave Blank)
If Cremation, Select Services (If Undecided, Leave Blank)
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):
Officiant Name
Officiant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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?
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?
Will you submit your own or will you be needing help to write one?
Father's Full Name
First/Middle/Last
Father is
Mother's Full Name
First/Middle/Last
Mother is
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?
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