14
Emwilton Place, Ossining, NY 10562 _ (914)
941 - 0167
Complete
this form to assure that your wishes are known.
FUNERAL PRE- PLANNING FORM and BURIAL
WISHES OF:
|
| Name
: |
| Social
Security Number : |
| Address
: ___________________________________________________________
Apt. # |
| City
: |
County
: ________________
State : |
| Date
of Birth : |
Birthplace: |
| U.S.
Armed Forces Serial Number : |
| Discharge
Papers : |
| Dates
of Service : |
Branch
: |
| Education/
Number of Years : |
| Occupation
: |
| Type
of Business : |
| Employer
/ City / State : |
| Name
of Father : |
| Maiden
Name of Mother : |
RELATIVES
AND FRIENDS TO BE CONTACTED : |
| Name
: |
Phone
: |
| Name
: |
Phone
: |
| Name
: |
Phone
: |
| Name
: |
Phone
: |
| Name
: |
Phone
: |
| Name
: |
Phone
: |
FUNERAL
PREFERENCES : |
| What
Type of Funeral : |
| Clergy
/ Rabbi : |
| Where
Funeral Service wil be Held : |
Casket
Bearers - Family or Professional:
|
Special
Requests :
|
Music,
Readings, Flowers, etc. :
|
| Type
of Casket : |
Clothing,
Jewelry, etc. :
|
| Type
of Burial : |
| Cemetery
: |
| Family
Burial Plot Location : |
| Section
: ____________
Plot : |
Lot
:__ __ _ _ _ _ _ _ ____
_ Range: |
| Grave(s)
:____________
Crypt : |
Mausoleum
:__ ___ _______
Tier : |
Other
Spaces in Plot Reserved for :
|
If
there is no Burial Plot arranged, where is Burial Preferred?
|
Obituary
:
|
| After
completing this form, please take it to Dorsey funeral director so the proper
arrangements can be made for the funeral. A copy of this form and other
burial preplanning paperwork needs to be kept with your life insurance policy
and Will. |
| Signature
- date : |
| Witnesses
- date : |