FUNERAL PLANNING QUESTIONNAIRE

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1 FUNERAL PLANNING QUESTIONNAIRE How to use this document: The Funeralwise.com Funeral Planning Questionnaire is designed to help you compile all the information you need when making arrangements for a funeral or when doing funeral preplanning. When using the form for a funeral that will take place right away, just complete the sections you need then print the form and take it with you when you visit your funeral director. When using the form for pre planning, you can complete the form over time and print your final copy for safekeeping. We recommend that you revisit your form from time totime to make sure your information stays up to date. Try our online funeral planner: Regardless of whether you are making arrangements for a service that will take place right away or pre planning a funeral that will take place sometime in the future, we suggest that you visit our FREE online funeral planner. Not only will you be able to change your information as the need arises, you'll be able to designate a Plan Guardian, someone you trust who can make sure your wishes are taken care of. Click here to visit the online planning tool. Written permission is required to reprint or reproduce this Funeral Planning Questionnaire. Requests can be made by to contact@funeralwise.com or by writing to: Funeralwise LLC, 601 Elmwood Avenue, Wilmette IL Copyright 2016 Funeralwise, LLC

2 FUNERAL PLANNING QUESTIONNAIRE TABLE OF CONTENTS SECTION 1: BASIC INFORMATIONN Primary Personal Informationn Information about the Person Making Arrangementss Notifications Filings and Notices Location of Important Information Travel Information Method of Final Disposition SECTION 2: DETAILED FUNERAL SERVICE INFORMATIONN Type of Funeral Service Plan Methods of Care Methods of Presentation Visitation Selections Transportation Selections Funeral / Memorial Service Selections Preferred Tribute Type Cemetery Information SECTION 3: DETAILED FUNERAL MERCHANDISE INFORMATION Funeral Merchandise SECTION 4: ADDITIONAL PERSONAL INFORMATION

3 F P Q SECTION 1: BASIC INFORMATION Primary Personal Information for you or the Person you are Plannin for: P I Name Last First Middle Suffi e.g., Sr., r. Se M / F Social Security No. Citienship country Ancestry Ethnic Group/Race Religion e.g., African American, Asian, Caucasian, ispanic, etc. R Residential Street Address Apt./nit Facility Name City County State ip Country B I Date of irth City of irth County State Country E I Person to Contact Physician Phone Phone I Date of Death Time of Death AM / PM Cause of Death Certifying Physician P Facility Name if applicable Address Type of Facility e.g., hospital, nursing home City County State ip Phone Page 1

4 F P Q Information Aout the Person Main Arranements Net of inresponsile Party: Name Last, First, Middle Address City State ip Day Phone Phone 2 E Mail Relationship to Deceased Notifications: P N Name Name Name Name Name Name Address Phone Address Phone Address Phone Address Phone Address Phone Address Phone C L Person Responsible for Funeral Arrangements Name Phone Address City State ip Attorney Name Firm Address City State Phone ip Eecutor of Estate Firm Name Address City State Phone ip Page 2

5 F P Q Filins and Notices if you are plannin for someone recently deceased: C Number of Death Certificates Required: Deliver To Quantity Phone Address O Newspapers ther Location of Important Information: Identify where the following important documents are located: Will irth Certificate Marriage License Social Security Card Citienship papers, if appropriate Military Discharge Papers Life and ther Insurance Policies Deeds and Titles to Property home, autos, etc ank Account Passbooks Income Ta Returns Certificates of wnership of urial Property ills to be Paid and other Financial Information Internet Site Passcodes Location of Safe Deposit o Financial Institution Phone Address City State ip Page 3

6 F P Q Trael Information if the deceased must e transported etween cities: Location where the deceased must be transported from: Funeral ome Address City State ip Telephone Fa Location where the deceased must be transported to: Funeral ome Address City State ip Telephone Fa Method of Final Disposition: C Whole body burial or entombment Cremation If cremation, specify disposition of ashes: urial or entombment at cemetery Deliver to survivors Scattering at cemetery ther Donation to medical science Specify Recipient rganiation, if one has been selected: rganiation Address City/State/ip Telephone ther: Specify e.g., burial at sea, scatter in outer space Also specify the Service Provider, if one has been selected: rganiation Address City/State/ip Telephone Page 4

7 F P Q SECTION 2: DETAILED FUNERAL SERVICE INFORMATION Type of Funeral Serice Plan: Choose a type of Funeral Service Plan: T includes a visitation and a funeral service in which the deceased is present in an open or closed casket includes one or more services without the presence of the deceased G includes one service held at the graveside prior to interment T P includes a visitation and a funeral service in which the deceased is present in an open or closed casket, plus one or more memorial services without the presence of the deceased the deceased is buried, cremated or donated to medical science without any funeral services Methods of Care: Select the following services regarding preparation and care: Do you want to have an embalming performed /N this may be required Do you want a DNA sample taken /N Do you want an autopsy performed /N this may be required Methods of Presentation: C P S Mae these selections if a Traditional or Traditional Plus Serice Plan has een chosen Select how you prefer the casket presented at the visitations: pen Closed Select how you prefer the casket presented at the funeral: pen Closed Do you want only a private family viewing /N Note: the deceased will be dressed and cosmetics will be applied if you have chosen to have a private family viewing or select to have an open casket presentation. If you do not wish to have the deceased dressed and cosmeticied for viewings, please eplain below how you would like the deceased to be presented: Page 5

8 F P Q Detailed Funeral Serice Information Continued C S New Eisting ewelry Clothing Selections to be made by: Visitation Selections: Mae these selections if a Traditional or Traditional Plus Serice Plan has een chosen Choose a location for the visitation: Funeral ome Church, temple, synagogue or other religious sanctuary ther Facility describe Indicate name, address and telephone of chosen location: Name Address City State ip Telephone Fa Transportation Selections: Mae these selections if a Traditional or Traditional Plus or raeside Serice Plan has een chosen Choose method of transporting the deceased between service locations and to the cemetery Funeral Coach or earse Funeral Van more economical Choose method of transporting family members between service locations and to the cemetery Limousine Sedan of people of people Family will provide transportation Escort Needed /N Instructions Page 6

9 F P Q Funeral Memorial Serice Selections: Mae these selections if a Traditional or Memorial or Traditional Plus Serice Plan has een chosen If there will e more than one serice mae additional copies of this section and complete it for each serice S S Indicate type of Service: Funeral Service Memorial Service Choose a location for the funeral service: Funeral ome Church, temple, synagogue or other religious sanctuary ther Facility specify Indicate name, address and telephone of chosen location: Name Address City State ip Telephone Fa C P Name Affiliation Phone Name Affiliation Phone P Mae these selections if a Traditional or Traditional Plus or raeside Serice Plan has een selected Active, onorary or Alternate Name Phone Name Phone Name Phone Name Phone Name Phone Name Phone Name Phone Name Phone Page 7

10 F P Q Funeral Memorial Serice Selections continued Title Title Title Title Title Artist Artist Artist Artist Artist P rganist Name Phone Vocalist Name Phone Name Phone Name Phone Name Phone R Title Source/Reference To be read by: Phone Title Source/Reference To be read by: Phone Title Source/Reference To be read by: Phone Title Source/Reference To be read by: Phone Page

11 F P Q Funeral Memorial Serice Selections continued F Florist Phone Floral Selection 1 Floral Selection 2 Floral Selection 3 Floral Selection 4 Description S S C Complete this section to proide instructions for special serice components such as a 21un salute horsedrawn procession or the rites of fraternal oraniations lie Masonic oraniations or Veterans of Forein ars Description Preferred Triute Type: Floral Masses Charitable Preferred Charity 1: Telephone Address: City/State/ip: Preferred Charity 2: Telephone Address: City/State/ip: Page 9

12 F P Q Cemetery Information: Complete this section if a urial or scatterin at the cemetery has een chosen Cemetery Name Address City State ip Telephone Fa Property Identification: Garden Lot Space Niche for urn SECTION 3: DETAILED FUNERAL MERCHANDISE INFORMATION Funeral Merchandise: C Manufacturer Model Model Name Identify type of casket: Wood Specify e.g., birch, cherry, mahogany, maple, oak, pine, poplar, walnut, etc. Precious Metal Specify brone or copper Sealed /N Steel Specify 16, 1 or 20 gauge Stainless /N Sealed /N Cloth covered ther Specify Identify lid style: alf Couch 2 piece Full Couch 1 piece Identify interior features: Material e.g., crepe, linen, velour, velvet Color Style e.g., shirred, tailored, tufted Special Features Page 10

13 F P Q Funeral Merchandise continued O B C Manufacturer Model Model Name Identify type of outer burial container: Grave o or Grave Liner Vault Lawn Crypt Specify e.g., concrete or wood Specify e.g., brone, copper, concrete, plastic, wood, composite Specify e.g., concrete or wood Special Features C U Manufacturer Model Material e.g., brone, ceramic, marble, wood G Manufacturer Model Identify type of grave marker: Model Name Model Name Grave Marker flush to the ground Specify e.g., brone, granite, marble Monument upright Lawn Crypt Specify e.g., brone, granite, marble Specify e.g., concrete or wood Engraving S P Guest Register ook: Manufacturer Style Quantity Prayer Cards: Manufacturer Style Quantity Verse to print on Prayer Cards: Memorial Folders: Manufacturer Style Quantity Verse to print on Memorial Folders Prayer ooks: Manufacturer Style Quantity Acknowledgement Cards: Manufacturer Style Quantity Manufacturer Style Quantity Page 11

14 F P Q SECTION 4: ADDITIONAL PERSONAL INFORMATION The followin information to the etent it is completed will e used for Oituary purposes and will proide a enealoy record for the family of the deceased I Marital Status single / married / widowed / divorced Spouse Name Last First Middle Suffi e.g., Sr., r. Se M / F Social Security No. Living /N irth Date Date of Death Address City State ip Country Telephone E Mail Marriage Data Date of Marriage City State Country P Father Data Name Last First Middle Suffi e.g., Sr., r. Living /N Date of Death irth Date Married /N Address irth Place Spouse Name if not Mother City State ip Country Telephone E Mail Mother Data Name Last First Middle Maiden Name Living /N Date of Death irth Date Married /N Address irth Place Spouse Name if not Father City State ip Country Telephone E Mail Page 12

15 F P Q Additional Personal Information continued C Child 1 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail Child 2 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail Child 3 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail Page 13

16 F P Q Additional Personal Information continued S rother/sister 1 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail rother/sister 2 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail rother/sister 3 Name Last First Middle Suffi e.g., Sr., r. Male/Female M/F Living /N irth Date Date of Death Married /N Spouse Name No. of Children Address City State ip Country Telephone E Mail G No. of Grandchildren No. of Great Grandchildren No. of Great Great Grandchildren Page 14

17 F P Q Additional Personal Information continued R City / State / Country No. of ears City / State / Country No. of ears City / State / Country No. of ears City / State / Country No. of ears E Elementary School igh School City/State City/State ear Graduated ndergraduate College ndergraduate Degree Graduate College Graduate Degree City/State ear City/State ear R ranch of Service ears Served From To Rank Wars Served Service Number Decorations Retired /N ear Retired Principle occupation No. of ears Industries Secondary occupation No. of ears Industries Employer 1 City/State ears From To Employer 2 City/State ears From To Page 15

18 F P Q Additional Personal Information continued Employer 3 City/State ears From To Employer 4 City/State ears From To R I Institution 1 Institution 2 P O rganiation 1 Positions eld rganiation 2 Positions eld rganiation 3 Positions eld rganiation 4 Positions eld rganiation 5 Positions eld N A Accomplishment 1 Accomplishment 2 Accomplishment 3 Accomplishment 4 Page 16

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