Online Preplanning Form

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ABOUT YOU (PERSON FILLING OUT FORM)

Name:

Email Address

Phone Number

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PERSONAL INFORMATION

Who is this plan for?

First Name

Middle Name

Last Name

Address of the Deceased:

Race or Ethnicity:

Was the Deceased in the Military?

If Yes, What Branch of Service?

If Yes, Do You Have DD214?

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FAMILY INFORMATION

Spouse's Name

Spouse's Maiden Name

Marital Status

Date of Marriage

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ADDITIONAL FAMILY MEMBERS

Mother's Name

Mother's Maiden:

Father's Name

Siblings (alive)

Siblings (deceased)

Children (alive)

Father's Address

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

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EDUCATION HISTORY

School Name

Highest Level of Education

School Location

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WORK HISTORY

Occupation:

Company Name:

Years at Company:

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YOUR WISHES

Visitation Options

Funeral Service Option

Would you prefer burial or cremation?

Final Disposition

Would you prefer to include a graveside/committal service?

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YOUR PREFERENCES

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Please list any interests or hobbies you would like to include into your services.

Get in Touch

Online Preplanning Form

Online Preplanning Form

Online Preplanning Form

Thomas E. Melvin & Son Funeral Home, Inc.

A Year of Grief Support