Prearrangement Form
Information about the person filling out this form:
I am filling this form out for: _______________________
Last:
First:
MI:
Street Address:
City:
State:
County:
Phone:
Zip:
Email:
Very important information about the person you are planning for:
Last:
First:
Gender:
Marital Status:
Social Security #:
-
MI:
-
DOB:
Place of Birth:
Spouses Full Name:
Spouses Maiden:
Place of Marriage:
Date of Marriage:
Mother’s Name:
Mother’s Maiden:
Father’s Name:
Anderson Funeral Homes www.andersonfuneralhomes.net
2200 Ludington Street Escanaba, MI 49829 906-786-4232
903 Wisconsin Avenue Gladstone, MI 49837 906-428-2211
Prearrangement Form
Work and Education
Education (primary:)
College:
Usual Occupation:
Type of Business:
Company:
Military Records
Branch of Service:
Serial #:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge of File at:
Copy of Discharge Papers? (Yes or No)
Name of Wars:
Funeral Service Information
Place of Service:
Place of Visitation:
I prefer the visitation to be: Public/ Private (circle one)
Viewing for Family: Yes/ No
Viewing for Friends: Yes/ No
Religious Denomination:
Place of Worship:
Lodge/ Union:
Anderson Funeral Homes www.andersonfuneralhomes.net
2200 Ludington Street Escanaba, MI 49829 906-786-4232
903 Wisconsin Avenue Gladstone, MI 49837 906-428-2211
Prearrangement Form
Person(s) to finalize Arrangements at time of Death
Check here and skip this section if information is the same as person filling out this form
Full name:
Street Address:
City:
State:
Phone:
Special instructions
Flower preference:
Music:
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:
Anderson Funeral Homes www.andersonfuneralhomes.net
2200 Ludington Street Escanaba, MI 49829 906-786-4232
903 Wisconsin Avenue Gladstone, MI 49837 906-428-2211
Zip:
Prearrangement Form
Disposition Options
I prefer:
Earth Burial/ Creamation/ Mauseleum
Cemetery:
Address:
Phone:
Section:
I have made a last will and testament? Yes/ No
Other Information and Special Instructions
Please list ANY other special instructions you may have for us:
Memorials and Charities
Please list and memorials or charity you would like
Contact Options
Send information about pre-arrangement:
Contact me to set an appointment:
Please keep my information on file:
Anderson Funeral Homes www.andersonfuneralhomes.net
2200 Ludington Street Escanaba, MI 49829 906-786-4232
903 Wisconsin Avenue Gladstone, MI 49837 906-428-2211