Pre-Plan Form

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral ceremony a personal tribute and assures your family that the service reflects your true wishes.

Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion when emotional stress make decisions difficult.

Because we realize individual wishes and situations are personal, we want to assure you of our high respect for complete confidentiality. We welcome the opportunity to meet personally with you and your family to discuss our services and your options more fully…or simply to answer questions. Or, you may prefer to file the necessary vital statistics and preferred funeral information with us by filling in the following information:

To maintain your privacy, as this is an unsecured site, we suggest you print a copy of the form to complete at home that you can bring with you to the funeral home.

Personal Information

Name (First MI Last):
Marital Status:
Social Security#:
Date of Birth:
Birth City & State
Race:
Hispanic Origin:
Came to Plymouth (year)
From: (City/State)
Residence Address:
City:
State:
County:
Zip:
Phone:
E-mail:
Spouse's Name:
Spouse's Maiden Name:
Spouse's SS#
Place of Marriage:
Date of Marriage:
Father's Name:
Mother's Name:
Mother's Maiden Name:

 

Work/Education History

Education(0-12):
College 1-5+:
Occupation:
Business:
Company:

 

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:
Church/Other:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Arrangments:
Address:
City:
State:
County:
Zip:
Phone:
E-mail:

 

Special Instructions

Flower Preference:
Music
Casket Bearers (6):

(leave blank if funeral staff to perform)
Jewelry:
Glasses:
Clothing:
Other:

 

Disposition Request

I Prefer:
Cemetery:
Address:
Phone:
Property Description:
I have made a last will and testament:
  Yes    No
Location:

 

Memberships/Affiliations

 

Other Instructions

 

Memorials/Donations To Charity

 

Please select one of the options

Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file

 

E-mail:  Info@Johnson-Danielson.com

 

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Johnson - Danielson Funeral Home

1100 N. Michigan Street
Plymouth, Indiana  46563
(574) 936-2829


Fax:  (574) 936-6160 


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