Preneed Information:

I am Pre-Planning for? Myself Parents Spouse Other   

If other, please provide relationship, name and contact number:

Name, Address, Place and Date of Birth:

First:      

Middle:         Birthdate: (mm/dd/yy):

Last:              Place of Birth, (State):

Address:        

Telephone Number:

City:              State:      Zip:

General/Statistical Information:

Social Security Number: 

Father's Full Name: 

Mother's Full Name (include Maiden Name):

Marital Status: Married Widowed Divorced Never Married

Name of Spouse: (First, Middle, Last and Maiden):

Date Married:   Place Married:

If Spouse Deceased, year:

Employment History:

Employment Status: Retired Employed Disabled Other Not Employed Occupation:

Employer: Number of years:

Schooling:

Please list schools attended from grade, middle, high school, trade schools and  College, Etc..:

Number of years of education completed:

Groups, Membership and Activities You Involved In:

Church affiliation:

Service organizations:

Clubs, noteworthy achievements, etc...:

Survivors:

Please list the names, cities and states of the following:

Spouse: (Include Maiden Name):

Children:

Grandchildren:

Parents:

Sisters:

Brothers:

Nieces and nephews: (No. of)

Other:

Service Information:

Final disposition: Burial Entombment Cremation Other

Visiting hours:

Place of funeral:

Clergy person:

Place of burial/cemetery:

In lieu of flowers, memorial contributions may be made to: 

Additional Service Information:

Pallbearers:

Special music:

Other information or instructions:

Veterans Information:

Branch of service: Army Navy Marines Airforce Coast Guard Other N/A

War:

Dates of service:

Honors/commendations:

Any other information you would like to keep on file with us:

This information will be kept on file at John M. Oakey & Son, Thank you.