Griffiths-Hovendick Chapel | Pre-Planning Form

This form is provided as a service to assist you in recording funeral preferences for yourself or a loved one. The information is needed for the various legal, media and service needs that arise following a death. Once you have filled in the information you may:

Press the Print/Submit button at the end of the form to send us the information
Press the Print/Submit button at the end of the form and then print the information and place it with your important papers

Once we receive this information, we will keep it on file and send you a letter (or email) of confirmation. You may contact us at any time if you have any questions or changes to make to your plan.

If you wish, you may set up an appointment for one of our funeral directors to meet with you and complete the pre-payment portion of these pre-arrangements (see Contact Us).


Personal Information
First Name:
Middle Name:
Last Name:
Maiden Name:
Gender:	Male Female
Address:
City:	State: Zip Code:
Phone Number:
Email:
Date of Birth:
Place of Birth:
Father's Name:
Mother's Maiden Name:
Nationality:
Marital Status:
Date of Marriage:
Place of Marriage:
Spouse's Name (Maiden Name):
Social Security Number:
Residence History:
Church Membership:
Memberships and Activities:
Hobbies/Interests


Work and Education
Education:	School:
College:	School:
Occupation:
Type of Business:
Name of Company:


Military Record
Branch of Services:
Serial Number:
Date Enlisted:
Rank at Discharge:
Date of Discharge:
Discharge on File At:
Military Outfit:
Name of Wars:
Commendations of Medals Received:


Funeral Service Information
Service Option Desired:	Traditional Funeral Service Traditional Funeral with Cremation Following Cremation with Memorial Service Immediate Cremation With No Memorial Service
Place of Service:
Person to Officiate:
Religious Denomination:
Organist and Soloist Preferred:
Favorite Musical Selections:
Favorite Bible Passage, Poem, Etc.
Casket Bearers (with phone #'s)	1. 2. 3. 4. 5. 6. Alternate:
Special Services/Ceremonies (Fratermal, Military, etc.)
Name of Cemetery:
City:	State:
Grave Location:
Other Funeral Instructions:
Memorial/Donations to Charity:
Whom in Charge:


Family Members Surviving
Spouse/Loved One:
Mother:
Father:
Children:
Number of Grandchildren:
Number of Great Grandchildren:
Additional Family Members:
Preceded in Death:


Person in Charge of Final Arrangements
Name:
Relationship:
Address:
City:	State:
Daytime Phone #:
Evening Phone #:
Last Will Location:
Other Questions or Comments:


Please Select any of the Following Options:
Send me information about pre-payment Contact me to set an appointment Keep my information on file

Personal Information

Work and Education

Military Record

Funeral Service Information

Family Members Surviving

Person in Charge of Final Arrangements

Please Select any of the Following Options: