Seymour Memorial Funeral Home

To be placed in the permanent files of Seymour Memorial Funeral Home.
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Person Completing this Form*:
Relationship*:

Preplanning Guide For
Full Legal Name*:	(no initials please)
Address:	(no P.O. Box)
City:
State:
Zip:
Date of Birth:	(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran?:	Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:	(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:

Names of Family Members(Where do they live? (City,State)
Family Member 1 Name:
City:
State:
Family Member 2 Name:
City:
State:
Family Member 3 Name:
City:
State:
Family Member 4 Name:
City:
State:
Family Member 5 Name:
City:
State:
Family Member 6 Name:
City:
State:
Family Member 7 Name:
City:
State:
Family Member 8 Name:
City:
State:

Person in charge of arrangements:

Place of service or gathering:
If Other, please specify:

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?


Do you wish to be contacted to discuss the details of these arrangements, cost or payment options? Yes No
If yes, how should we contact you?:
Phone Number:
Email:
If no, we will keep this information on file until you or your surviving family requests it.
	Enter Security Code: