• Advanced Funeral Planning will express your personal wishes.
  • Advanced Funeral Planning relieves your family from making difficult decisions at a time of sorrow.
  • Advanced Funeral Planning will give your family the security and satisfaction, knowing that the arrangements you have planned are guaranteed once it has been funded.

Evans City

Zelienople

If you are ready to begin, or have any questions about the Advanced Funeral Planning process, give us a call at: 724-538-8123, or fill out the form below.

Personal Information
Name
(First MI Last):
Marital Status:   Social Security #:
Date of Birth: Place Of Birth:
Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Place of
Marriage: 		Date of Marriage:
Father's Name: Mother's Name:
Mother's Maiden Name:
Person in Charge:
Address:
Phone:
Physician's Name:


Work/Education History
Education (0-12):
 College 1-5+:
Occupation:
Industry:
 Employer:
Schools Attended and Graduation Years

Military Record
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Copy of Discharge Papers:     Yes     No
Name Of Wars:

Funeral Service Request
Place Of Service:
Length of Visitation:
Hours of Visitation:
Religious Denomination:
Place Of Worship:

Newspaper Information (Please list family members)
Spouse:
Parents:
Children:
Brothers/Sisters:
Grandchildren:
Great Grandchildren:
List any other significant relatives :

Special Instructions
Lodges, Organizations, Unions, and Offices held:
Jewelry:
Glasses:
Person in Charge of Final Arrangements:
Clothing Preference: My own Other
Funeral Luncheon Site:


Disposition Request
I Prefer:
Cemetery:
Address: Phone:
Section:
Lot #:
Grave #:

If cremation, final disposition of cremated remains should be?
Burial Location:
Scattering Location:


Other Instructions

Memorials/Donations To Charity

Please select all that apply:
Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file


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