Strode Funeral Home

Strode Funeral Home Funeral Pre-planning Form I am planning for: MyselfSpouseLife PartnerMotherFatherChildFriendOther Relative Your Last Name: Your First Name: Your Middle Name: Your E-mail Address: Your Street Address: Your City: Your County: Your State: Your Zip Code: Your Home Phone: Your Work Phone: Full name of person you are planning for (if not yourself): Sex: Marital Statis: Social Security Number: Date of Birth: Place of Birth: Spouse's full name: Spouse's Maiden name: Place of marriage: Date of marriage: Father's full name: Mother's full name: Mother's Maiden name: Education: Usual occupation: Kind of business: Company: Branch of military service: Military Serial Number: Date enlisted: Rank at Discharge: Date Discharged: Discharge on file at: Copy of Discharge papers: NoYes Name of war(s): Place of funeral service: Funeral HomeChurchCemetery Name of funeral home: Address: Phone: Place of Visitation: Funeral service should be: PublicPrivate Viewing for family: YesNo Viewing for friends: YesNo Religious denomination: Place of worship: Lodge/Union: Name of person to finalize Arrangements at time of death: Street Address: City: County: State: Zip Code: Home Phone: Work Phone: Flower preference: Music preference: Jewelry preference: Glasses: Clothing preferences: Names (6) of casket bearers: Other Special Instructions: Disposition preference: Earth BurialMausoleumCremation Cemetery: Address: Phone: Section: Person planned for has a last will and testiment: YesNo Survivors (to be listed in Obituary): Predeceased (to be listed in Obituary): Other Information or Special Instructions: Memorials and Charities: Options: Send information about pre-arrangement Contact me to set up an appointment Please keep my information on file