Prearrangement Information For Your Assistance

One of the most caring, loving things you can do for your family is to leave detailed information, which permits them to make the funeral ceremony a personal tribute, and assures your family that the service reflects your true wishes.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion when emotional stress make decisions difficult.

The following form will help you compile the necessary personal information about yourself, which is necessary to have on hand for the death certificate and other legal documents. It is a good idea to take a few minutes and fill it out now. You may print this form and keep it with your important papers or e-mail it to us and we will place it in our confidential files for safe record keeping.

Personal Information

Name (First MI Last):
Marital Status:   Choose One Never Married Married Divorced Widow Widower	Social Security #:
Date of Birth:		Birth City & State
Race:		Hispanic/Haitian Origin:   Choose One Yes No
Came to Citrus County in: (year)		From: (City/State)
Residence Address:
City:		State:
County:		Zip:
Phone:		E-mail:
Spouse's Name:		Spouse's Maiden Name:
Spouse's SS #		Place of Marriage:
Date of Marriage:		Father's Name:
Mother's Name:		Mother's Maiden Name:
Work/Education History
Education(0-12):
College 1-5+:
Occupation:
Business:
Company:
Military Record
Branch of Service:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Discharged:		Discharge On File At:
Copy of Discharge Papers:     Yes     No
Name Of Wars:
Funeral Service Request
Place of Service:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge/Union:
Person in Charge of Final Arrangements:
Address:
City:		State:
County:		Zip:
Phone:
E-mail:
Special Instructions
Flower Preference:
Music:
Casket Bearers (6): (leave blank if funeral staff to perform)
Jewelry:
Glasses:
Clothing:
Other:
Disposition Request
I Prefer:	Choose One Earth Burial Mausoleum Entombment Cremation Out-of-State Transfer Body Donation Other
Cemetery:
Address:		Phone:
Property Description:
I have made a last will and testament:     Yes     No
Location:
Memberships/Affiliations
Other Instructions
Memorials/Donations To Charity
Please select one of the options below
Send information about pre-arrangement Contact me to set an appointment Please keep my information on file
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