Pre-Planning Form

Personal Information

First Name Middle Last Address Province Postal Code Date of Birth Place of Birth Age Years at current residence Moved from Education (years) Education history Occupation Company Name Type of Industry Years employed Retirement date Soc. Sec. # Spouse If deceased (date) Wife's maiden name Ancestry (nationality) Father's name Mother's maiden name

If you are a Veteran, please complete

Branch of Service Serial # Rank Date of Entry Place of Entry Date of Discharge Place of Discharge

Memberships

Please list memberships. Examples: Church, Fraternal, Civic, Etc.

Survivors

Please list names, relationship and residence.

Service Information

Where would you prefer that your service be held? Where is your cemetery property? Musical Preferences Pallbearers Memorial Contributions

Responsible Party Information

First Name Middle Last Address City Province Postal Code Phone Cell Work Soc. Sec. #

cforms contact form by delicious:days

Pre-Planning Form

Pages