PRE-PLANNING

This document is presented as a guide to the information needed by Metz Mortuary when arranging an at-need or prearranged funeral. If you submit this form to Metz Mortuary, we will keep it on file. Not all the fields are required to be filled out. You may also wish to print this form and keep it with your other important papers.

Biographical Information

This Guide is for	myself spouse mother father child friend other	Full Name:
Email address:		Full Phone Number:
Address Information
City, State, ZIP		Resident Since:
Country of Citizenship:
Place of Birth
City, State, ZIP		Date of Birth:
Social Security Number:
Parents
Father's Name:		His Place of Birth:
		His Date of Birth:
Mother (Maiden Name)		Her Place of Birth:
		Her Date of Birth:
Family
Marital Status:	married single divorced separated widowed	Spouse (Maiden Name):
Work History
Occupation		Employed by:
		Retirement Date:
Education
Elementary:
High School:
College:
Military Service:
Branch:		Date of Enlistment:
Rank:		Date of Discharge:
Serial Number:		Location of Discharge:
Funeral Preferences
Type of Service	public private	Visitation:	yes no
Place of Service	funeral home church other	Other
Conclude Service at	funeral home graveside church reception hall other	Other
Religious Denomination
Place of Worship
Type of Clergy
Type of Interment	burial cremation entombment	Casket Type	wood steel copper bronze cremation urn
Special Instructions
Favorite Bible Passages:		Music to be Sung:
Literature or Poems:		Music to be Played
Flowers
Flower Color:
Donations:
Final Disposition
Preference	Ground Interment with burial vault concrete liner Mausoleum Entombment Cremation with niche entombment burial home memorialization scattering	Cemetery Name
		Cemetery Address
Finalizing Arrangements
Do you have a will?	yes no	Executors Name
Lawyers Name		Executors Address
		Executors Phone Number
		Executors Email Addr:
	Executors Relationship to You:
Relatives and Friends to Notify
Name and Relationship		Addr and Phone
Name and Relationship		Addr and Phone
Name and Relationship		Addr and Phone