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Please be aware that this form does not 
obligate you to use Glenwood Funeral Homes!

The following form is used to assist you in obtaining the needed personal information necessary for making funeral arrangements.  This personal information will help us obtain death certificates, prepare obituaries, and complete other clerical documents.  This form can be used several ways.  

First of all, this form may be printed, filled out and filed for easy accessibility at a later date.  Secondly, you may mail a completed copy of this form to our office if you are not comfortable filling it out online.  Lastly, you may complete the form and submit it online to our office staff.  

 Regardless of the method you choose, we suggest that you keep a copy of your arrangements and discuss them with your family so that everyone is aware of your wishes.

We will never use or share this information for other than its intended purpose.

 

   If you are making these arrangements for someone else other than yourself, 
please enter your name, contact information, and relationship in the box below.

ARRANGEMENTS FOR:

Full Name      Male     Female

  Date of Birth

Current Address

City      State      Zip      Telephone

E-mail

Resident Since      Moved Here From

Birthplace      Nationality

Father's Name (first, middle, and last)

Mother's Name (first, middle, maiden, and last)

Current Marital Status: Never Married    Married    Divorced    Widowed

Date of Marriage      Place of Marriage

Full Name of Spouse (maiden)      If Deceased, Year of Death

Children (Names, Addresses, and Spouses)

Siblings (Names and Spouses)

Number of Grandchildren      Number of Great-Grandchildren

Occupation      Business Type

Employer

Education (Names of schools, last grade completed, and graduate of)

Religion      Church Member of

Activities and/or Hobbies

Were you in the military?   Yes     No          If so, which Branch?

Rank      Service Number

Enlistment Date      Enlistment Place

Discharge Date      Discharge Place

War Veteran   Yes     No          If so, which one(s)

Name of Primary Care Physician

Funeral Service Preference

I request    Burial     Cremation

If your arrangements include cremation, will the ashes be
Buried   Scattered   Returned to Family

I would request a
Traditional Service  Graveside Service  Memorial Service  No Service

Would you like public visitation?   Yes     No

If you selected a traditional or memorial service, please indicate the preferred location.

Name of the Clergy/Officiator

Cemetery      City

Special Instructions

Payment Preference

Pre-Pay  Burial Insurance  Other

Today's Date 

After completion of this form, please click the submit button below.  Thank You.