Dear Friends

Dear Friends:

The information you provide for your funeral pre-arrangement will be kept on file at the funeral home. Once this information is received, you will be contacted by an Advanced Planning Specialist to confirm receipt of your pre-arrangement. If you would prefer to speak directly with us to provide any of the items listed below (such as your Social Security number and any other personal data), you may contact us at (734) 482-9889 and we will add those items to your pre-arrangement. Thank you for taking the time to record your information. You may update your file at anytime by contacting our office or by emailing any changes to us Community Home for Funerals

The Community Home for Funerals Family

Vital Statistics (Required)

Name				Date
Street Address				City
State/Province				Zip/Postal Code
Area Code				Social Security Number
Home Phone				Birth Date
Birth Place
Father's Legal Name
First		Middle Initial		Last
Mother's Legal Name
First			Middle Initial	Last Name	Maiden Name
Marital Status

Single	Married			Separated		Divorced
Widow(er)
Spouse	Date of Marriage			Place of Marriage		Death Date
Spouse	Date of Marriage			Place of Marriage		Death Date
Ancestry/Nationality (English, French, German, etc.) (Please list all that apply)
Doctor's Name				Doctor's Phone
Street Address				City, State

Personal History

Employment
Occupation	Employer
Position Held	How Long
Retired	Yes No	Year
Please provide more information on any other jobs you have had:

Resident Cities	Number of Years





Education		Highest Grade Completed (including college, in total number of years)
High School College- list all attended and degree earned

Military
WWII	Korean	Vietnam	Other
War		Branch of Service (ie Army, Navy, etc)
Enlistment Date (If known)		Rank
Discharge Date		Enlistment Place (If known)
Service Number		Discharge Place
Reserves?

Special Affiliations Lodges, Memberships, Church, Public Office Held, Fraternal Organizations? (Indicate past or present affiliation)
UAW Member?	Local #
Hobbies and special interests

Newspaper
The funeral home will notify the local newspaper (The Flint Journal)
Other Papers to Notify

Photo in Obituary?	Yes	No

Immediate Family

Name & Spouses Name	Relationship	City, State	Phone#


















If additional space is needed for family members, please write those on the comments section here
A Special Thanks To:
Preceded in Death By

Local Emergency Contacts to be Notified at time of Death

Name and Relationship	Street Address	City, State	Phone#

Important Legal Information For Family Use

Will Location		Safety Deposit Box Location
Attorney		Telephone Number
Address
Executor of Estate		Telephone Number
Address

Additional Information (List any insurance policies, etc.)

Durable Power of Attorney
Living Will
Living Trust
Receiving VA Benefits?	Yes No	(Funeral Home Will Notify at Time of Death)
If yes, are you a disabled vet? or a retired person?
Receiving Pension?	Yes No	(Funeral Home Will Notify at Time of Death)
Receiving Social Security	Yes No	(Funeral Home Will Notify at Time of Death)

Final Wishes and Desires

Cemetery		Location City/State
Section		Lot
Space		Marker Installed
Name of Cemetery Property Owner

Specific Instructions

Funeral Service at: Funeral Home Church Other		Graveside
Funeral Service at: Funeral Home Church Other		Rosary
City/State		Prayer Service

Remarks

Clergy			Organist
Church			Vocalist(s)
Favorite Bible Passages, Poetry, Quotations and Verses, Etc.			Music Selections

Flower Requests (Color/Choice of Flowers)		Piece 1
Piece 2
Piece 3
Piece 4
Clothing
New		Present
Color		Jewelry
Decisions of clothing to be made by:

Participating Organizations (List all that apply including Masonic Lodge and its number, Veterans/VFW Lodge and its number, Knights of Columbus, Eastern Star, and any Fraternal/Military Rites)
Pallbearers:
Name	City, State	Phone#
1.
2.
3.
4.
5.
6.
Alternates/Honorary

Special Instructions
Memorial contributions to:
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