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Preplanning Checklist
Full Legal Name____________________________________________________________
Legal Address_____________________________________________________________
City____________________________State_____________________________________
Sex___________Race_____________Citizen of__________________________________
Birthdate_______________________Birthplace__________________________________ Birth Certificate Location_____________________________________________________
Single___ Married____ Widowed____ Divorced_____
Marriage Certificate Location__________________________________________________
Name of Spouse___________________________________________________________
Maiden name of wife________________________________________________________
Date Married______________ Place Married_____________________________________
If Spouse is Deceased, Date____________ Place of Death__________________________
Education(0-12, # of Yrs)______ College(# of Yrs)__________________________________
Social Security Number ______________________________________________________
Occupation________________________________________________________________
Employed By______________________________________________________________
Location: city/state__________________________________________________________
Date of Retirement__________________________________________________________
Mothers Maiden Name_______________________________________________________
Fathers Name_____________________________________________________________
Attorney's Name___________________________ Telephone________________________
Will Location______________________________________________________________
Accountant's Name_________________________ Telephone________________________
Executor_________________________________ Telephone________________________
Stockbroker_______________________________ Telephone_______________________
Bank_____________________________ Account Numbers_________________________
Safe Deposit Box (bank)__________________Box Number__________________________
Life Insurance _____________________Policy Number_____________________________
Pension or Union Plan_______________________________________________________
Real Estate Broker ___________________________Telephone______________________
Automobile Registration______________ Insurance Agency__________________________
Church _____________________Church Telephone_________Clergy Name____________
Cemetery Name______________________ Plot Number____________________________
Funeral Service To Be Held___________________________________________________
Music____________________________________________________________________
Clothing__________________________________________________________________
Visitation - Calling Hours_____________________________________________________
Pallbearers_______________________________________________________________ ________________________________________________________________________
Flowers__________________________________________________________________
Memorials________________________________________________________________
Personal Requests: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
You may print this to help you with your preplanning. We will be happy to assist you with the many details in your preplanning arrangements. Please feel free to call us.
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