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Pre-Need
Form
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Pre-Need Forms
are a
personal guide to help relieve your family and loved ones of the burden of
decisions. Take time now to complete the following form. Upon
completion, print this page for your own copy, and click on the submit button at
the bottom of the form to send a copy to
CE
Willie Funeral & Cremation Services. |
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To My Loved Ones, |
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It is my desire that you be spared from anxiety, expense and inconvenience
at the time of my death. |
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In this Gift of Love form,
you will find information I have recorded and a plan which represents
arrangements I have made in advance, hoping to relieve you of the burden of
these decisions at the time of need. If you give this booklet to a funeral
director, everything will be conducted in accordance with my wishes. |
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Also recorded here are
certain vital statistics that will be needed, along with a list of important
documents you will need. |
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I certainly hope you find
these arrangements satisfactory and they help you retain a warm memory of the
wonderful years we have spent together. |
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With
Love, |
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Historical
Record
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| Today's
Date: |
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| Name: |
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| Address: |
# of years at
address:
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| City: |
County:
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State: |
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| Zip
Code: |
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| Tele.
No.: |
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| Education: |
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| Birth
Date: |
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Current
Age:
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| Birthplace:
City |
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County
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Occupation:
(Previous if
retired) |
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Employer:
(Or retired
from) |
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| Marital
Status: |
Single Married
Widowed
Divorced |
| Spouse
Name: |
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| Maiden
Name: |
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| Date
of Marriage: |
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| Place
of Marriage: |
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In
State Since:
(19xx or
20xx) |
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In
City Since:
(19xx or 20XX) |
| Moved
From: |
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| Social
Security #: |
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| Name
of Father: |
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| Date
if deceased: |
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| Birthplace:
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(City) (State) |
| Name
of Mother: (Maiden) |
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| Date
if deceased: |
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| Birthplace:
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(City)
(State) |
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Veteran
Information
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| Name
of War: |
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Service Number: |
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| Branch
of Service: |
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| Place
Inducted: |
Date: |
| Place
Discharged: |
Date: |
| Rank/Rate
when discharged: |
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| Discharge
papers located: |
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| Flag
to drape casket: |
Yes
No |
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Personal
Wishes and Desires
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This
is information families never discuss -- especially the children. But
yet, if something had happened to you last night, these are the
questions your funeral director would be asking your family today.
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Would
you have had your service:
At
the funeral home the
church other
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What
is the name of your church?
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Who's
your favorite minister, priest or rabbi?
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Are
there any readings or scriptures that are special to you?
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Many
people have a favorite song or hymn. What's yours?
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| Some
families prefer a memorial donation instead of flowers. What is
your feeling? |
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Memorial Donation
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Flowers
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Both
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What
clothing would you prefer?
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Would
you like to wear jewelry?
Yes No
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To be
removed?
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Yes
No
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Would
you like to wear your eyeglasses?
Yes
No
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Do
you have cemetery property?
Yes
No
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Name
and Location of Cemetery:
Lot # Space#
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Most
families prefer to have friends, neighbors, or relatives serve as active
or honorary pallbearers. Who would you prefer?
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| Active
Pallbearers: |
Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
| Honorary
Pallbearers: |
Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Name:
Phone: |
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Names
of Children
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| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
| Name:
Phone No.: |
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Address: |
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| Brothers
& Sisters |
| Name:
Relationship:
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Address: |
| Name:
Relationship: |
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Address: |
| Name:
Relationship:
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Address: |
| Name:
Relationship:
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Address: |
| Name:
Relationship:
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Address: |
| Name:
Relationship:
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Address: |
| Name:
Relationship: |
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Address:
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| Good
Samaritans |
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This
is where we list your closest friends in the event your family needs
help at the time of need by:
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- Notifying
friends
- Running
errands
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- Handling
sympathetic phone calls
- Helping
out-of-town guests
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| 1. |
| 2. |
| 3. |
| 4. |
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Would
you like to schedule an appointment to discuss prepaid funeral
arrangements?
Yes
No
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If
yes, what is the best way to contact you?
E-mail
Enter e-mail address here:
Phone
Enter phone number here: Area Code first-
U.S.
Mail Enter complete mailing address. Address:
City:
State:
Zip: |
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For
the purposes of relieving my family in the event of need, the preceding
arrangements are my personal wishes and desires.
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Note:
Don't forget to print this form for your own records (hit print located
on your browser)
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| After
you submit your information you will be returned to our home page |
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