Wenburg Funeral Home - Beaver City & Arapahoe, Nebraska

Pre-arrangements

Being prepared..... is having peace of mind.

This form is a guide to the information requested by your funeral director when making funeral arrangements. Please fill out the form as completely as possible (not all fields must be filled out). Let us know if you have any questions.

Name of the person filling out this form (First Last):
Your phone number:
Your email:
I am planning for

Personal Information

Full Name (First Middle Last):
Gender:
Marital Status
Address:
City:
County:
State:
Zip:
Phone:
Social Security Number:
Date of Birth:	(mm/dd/yyyy)
Place Of Birth:
Spouse's Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:	(mm/dd/yyyy)
Place of Marriage:
Father's Name:
Mother's Maiden Name:
Current surviving family (information will be updated at the time of death):
Preceded in death by:

Education Level:	Primary:
	Secondary:
Occupation:
Employed by:	# Of Years:
Retired in:

Service Branch:
Date Enlisted:	(mm/dd/yyyy)
Date Discharged:	(mm/dd/yyyy)
Rank At Discharge:
Discharge On File At:
Location of my discharge:
Name of any wars served in:

I Prefer My Funeral Service To Be:
Place Of Service:
Religious Denomination:
Place Of Worship:
Worship leader:
Name of worship leader:
Casket Bearers (6):	1.
	2.
	3.
	4.
	5.
	6.

Musical Selections
To Be Played: 1.

2.

3.

4.

Will Supply CD/Tape

Musical Selections
To Be Sung: 1.

(usually use two selections) 2.

3.

4.

Favorite Bible Passages:

Favorite Literature or Poems:

Favorite Flower(s):

Favorite Flower Color:

Please list any memorials or donations to charity that you would like:

Preference for final disposition is (check one):	Ground interment with
	Mausoleum
	Cremation with
Preference of cemetery:
Address of cemetery:
Check if a cemetery plot is owned at the above location

Special Instructions

Name:

Relationship:

Address:

City:

State:

Zip:

Phone:

E-mail:

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