Pre-Plan Form

Benefits of Preplanning   How to Plan Your Funeral   Funeral Checklist   Frequently Asked Questions

 

    Pre-Need Forms are a personal guide to help relieve your family and loved ones of the burden of decisions.  Take time now to complete the following form.  Upon completion, print this page for your own copy, and click on the submit button at the bottom of the form to send a copy to Goolsby Mortuary

To My Loved Ones, It is my desire that you be spared from anxiety, expense and inconvenience at the time of my death

In this Gift of Love form, you will find information I have recorded and a plan which represents arrangements I have made in advance, hoping to relieve you of the burden of these decisions at the time of need.  If you give this booklet to a funeral director, everything will be conducted in accordance with my wishes.

Also recorded here are certain vital statistics that will be needed, along with a list of important documents you will need.

I certainly hope you find these arrangements satisfactory and they help you retain a warm memory of the wonderful years we have spent together.

With Love

Historical Record
Today's Date:
Name:
Address:     # of years at address: 
City:   County:
State:
Zip Code:
Tele. No.:
Education:
Birth Date: Current Age: 
Birthplace:  City County 
Occupation:
(Previous if retired)
Employer:
(Or retired from)
Marital Status: Single       Married       Widowed      Divorced
Spouse Name:
Maiden Name:
Date of Marriage:
Place of Marriage:
In State Since:
(19xx or 20xx) 		 In City Since:
(19xx or 20XX)
Moved From:
Social Security #:
Name of Father:
Date if deceased:  
Birthplace:  (City)   (State)
Name of Mother: (Maiden)
Date if deceased:  
Birthplace: (City)   (State)
Veteran Information
Name of War:
Service Number:
Branch of Service:
Place Inducted:      Date:
Place Discharged:      Date:
Rank/Rate when discharged:
Discharge papers located:
Flag to drape casket: Yes            No
Personal Wishes and Desires
This is information families never discuss -- especially the children. But yet, if something had happened to you last night, these are the questions your funeral director would be asking your family today.
Would you have had your service:  At the funeral home       the church     other  
What is the name of your church? 
Who's your favorite minister, priest or rabbi? 
Are there any readings or scriptures that are special to you? 
Many people have a favorite song or hymn.  What's yours?  
Some families prefer a memorial donation instead of flowers.  What is your feeling?
Memorial Donation  Flowers   Both
What clothing would you prefer? 
Would you like to wear jewelry?    Yes    No
To be removed? Yes      No
Would you like to wear your eyeglasses?   Yes    No
Do you have cemetery property?    Yes    No
Name and Location of Cemetery:    
Lot # Space#
Most families prefer to have friends, neighbors, or relatives serve as active or honorary pallbearers.  Who would you prefer?
Active Pallbearers: Name:      Phone:
Name:      Phone: 
Name:      Phone: 
Name:      Phone: 
Name:      Phone: 
Name:      Phone: 
Honorary Pallbearers: Name:      Phone:
Name:      Phone:
Name:      Phone:
Name:      Phone:
Name:      Phone:
Name:      Phone:
Names of Children
Name:       Phone No.:
           Address:
Name:       Phone No.:
           Address:
Name:       Phone No.:    
           Address:
Name:       Phone No.:
           Address:
Name:       Phone No.:
           Address:
Name:       Phone No.:
           Address:
Name:       Phone No.:
           Address:
Brothers & Sisters
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Name:     Relationship:
            Address:
Good Samaritans
This is where we list your closest friends in the event your family needs help at the time of need by:
  • Notifying friends
  • Running errands
  • Handling sympathetic phone calls
  • Helping out-of-town guests
1.
2.
3.
4.
 
Would you like to schedule an appointment to discuss prepaid funeral arrangements?
Yes           No
If yes, what is the best way to contact you?
E-mail        Enter e-mail address here:

Phone        Enter phone number here:  Area Code first-

U.S. Mail   Enter complete mailing address.   Address:
                       City:    State:     Zip:

For the purposes of relieving my family in the event of need, the preceding arrangements are my personal wishes and desires.

Note: Don't forget to print this form for your own records (hit print located on your browser)

 

our history   |   tour   |   services   |   obituaries   |   pre-plan   |   contact   |   location   |   links   |   home

 

Goolsby Mortuary  1375 Jonesboro Rd. SE   Atlanta, GA 30315 webmail

Office: 404.588.0128   Fax: 404.588.0502  Email: info@goolsbymortuary.com

Google
Copyright © 2001 Goolsby Mortuary. All rights reserved.

Site designed by: articdesigns.com