This online form is temporarily out of order.  Please call our office (432) 381-9000 for assistance in preplanning.  Or you may call our preneed counselor, Susan, directly at (432) 352-8649.

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This form was designed to assist you in recording important information that is needed when death occurs:

Full Legal Name:
Preferred Name for Obituary:
Home Address:
City, State Zip Code: ,
Telephone: Inside
City Limits:
County: Length of Residence:
Prior Residence:
Sex: Race: Spanish Origin:
Date of Birth: Place of Birth:
Maiden Name of Deceased: Education/
Years:
Father's Name:
Mother's Maiden Name:
Marital Status:
Occupation: Kind of Business:

Military Information
Organization: Rank:
Date Entered: Place:
Date Discharged: Place:
Serial No.: Claim No.:
Church Affiliation:
Organizations:

Services
Place:
Minister:
Interment:
City: County: Section:
Block: Lot: Space:
Family Visitation:
Memorials To:
Newspapers to Notify:
Suggested Readings, Poetry, etc:
Floral Preference:
Clothing and Jewelry Preference:
Instructions for Hairdresser:
Pallbearers:
Honorary Pallbearers:
Organizations to Participate in Service:

Survivors Information
Spouse:
Parents:
Grandparents:
Children:
Brothers/Sisters:
Grandchildren:
Additional Information:
Information Provided by:
E-mail Address:
Date:

Print this Prearrangement form from
your computer for your records.
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Please keep my information on file


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