Meridith Funeral Home, P.C. - Pre-planning Form

Pre-planning Form

This form was created to conveniently and accurately collect the needed information required to proceed with the funeral process.

Please complete the following. The fields with an astrict * beside are required.

If you have any questions regarding this form, please feel free to contact Meridith Funeral Home so that we may gladly assist you.

First & Middle Name*	Last Name*

Address*	City*

State*	Zip*

Telephone*	E-mail Address*

Date of Birth*	Birthplace*

This next section concerns the Father's information.
First & Middle Name*	Last Name*

Address	City

State	Zip

(or) Date of Death
/ /
This next section concerns the Mother's information.
First & Middle Name*	Maiden Name*

Address	City

State	Zip

(or) Date of Death
/ /
This next section concerns Death Certificate information.
Highest Level of Education*	Social Security Number*
	(For security provide by phone.)
This next section concerns the Decendents' information.
Children's Names City / State Grand Children's Names City / State Brothers' / Sisters' Names City / State Predeceased Family Members
This next section concerns personal information.
Occupation / Industry	Name of Employer

Veteran	Church Affiliation

Other Memberships

This next section concerns the funeral procession.
Funeral Instructions	Clergy

Pall Bearers	Place of Service

	Funeral Home

Organist	Soloist

This next section concerns cemetery information.
Name	Location

Lot	Grave #

Casket Preferences	Vault Preference

Any other wishes or special instructions not mentioned above