Evans Funeral Home: Advance Planning

The concept of funeral pre-planning often seems of little importance to most people – that is until a death has occurred in their family. Then suddenly, the value of pre-planning becomes clear. The myriad of decisions that need to be made, the legal information that needs to be gathered, and the arrangements that must be made with the mortuary, clergy, cemetery, and other parties, all at a time when one is least able to make these decisions, can all be avoided through a little foresight and planning.

Please answer the following questions.
When you are finished, press "submit" to continue.

Vital Statistics:
Full Legal Name of the Person this Plan is For:
Date of Birth (MM/DD/YY):
Age: Sex:	Social Security Number:
Place of Birth (City and State or Country if not in USA):
Temporary Address (If applicable; Street, City, State, Zip):
Temporary Telephone Number (with area code):
Permanent Address (If applicable Street, City, State, Zip):
Permanent Telephone Number (with area code):
Email Address:
Do you live inside the city limits? Yes No
What is your race?
What is your nationality or ancestry?
What is your marital status? Married Divorced Widowed Never Married
Name of Spouse (If Wife, give Maiden Name):
Your Occupation (Job title when working):
In What kind of Business or Industry?
How many years in school?	How many years of College?
Father's full name:
Mother's full maiden name:
Have you ever been in the U.S. Armed Forces? Yes No
Legal Name of Next of Kin or Responsible Party:
Address of Next of Kin or Responsible Party (Street, City, State, Zip):
Telephone Numbers of Next of Kin or Responsible Party:
Home (with area code):
Work (with area code):
Mobile (with area code):
Name of family doctor:
Family doctor's Address:
Family doctor's telephone number (with area code):
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Preferred Funeral Arrangements (choices that you make):
Visitation (Calling on the Family of a loved one to offer support and sympathy)
I Prefer a Private Visitation for my Family at the Funeral Home
I Prefer a Private Visitation for my Family at my church
I Prefer a Public Visitation at the Funeral Home
I Prefer a Public Visitation at my church
During Visitation I prefer that my Casket remain closed
During Visitation I prefer that my Casket remain open
I Prefer No Visitation as I wish to be Cremated
I Prefer No Visitation but I would like a Funeral Ceremony
Vigil or Wake (a.k.a. Rosary) Service (Generally a Religious Ceremony Performed in the Evening)
Yes, I would like an Evening Vigil or Wake Service
No, I would not require a Vigil or Wake Service
Funeral Ceremony (Generally a Religious Ceremony Performed during the Day followed by the Committal at the place of Disposition)
I Prefer a Religious / Memorial Ceremony to be held at My Church
I Prefer a Religious / Memorial Ceremony to be held at the Funeral Home
I Prefer a Religious / Memorial Ceremony to be held at some Other location (detail here):
I Prefer No Religious / Memorial Ceremony
Committal / Final Disposition (This means placement in the final resting place of your choice)
I Prefer Ground Interment / Burial
I Prefer Mausoleum Entombment
I Prefer Cremation with the following disposition of my ashes: Ground Interment of urn Placement of urn in Niche Private Placement of urn Scattering of ashes
Family Fellowship after the Funeral
I Prefer a Luncheon be held at this location (enter here):

I have no Preference
I Prefer No Luncheon after my Funeral
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Veteran's Section:
No, I am not a Veteran (Skip this section)
Yes, I am a Veteran
I served my Country in the (Branch of Service):
I entered the Service on (MM/DD/YY):
I entered the Service at this location:
I left the Service on (MM/DD/YY):
I left the Service at this location:
I attained the rank of:
My service serial number is:
I have visited a V.A. Hospital and my C number is
As an eligible Veteran of this Country I request a U.S. Flag be Draped on my Casket Folded in a triangle by my Casket Folded in a triangle for my Memorial Ceremony Folded in a triangle for private presentation after funeral
I request a Government Headstone / Marker for my final resting place Granite Bronze
I request full Military Honors at my funeral
If I qualify, I request any V.A. Burial Allowance funds
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Details of Funeral Ceremony: (Optional, however this may help your family to fulfill your wishes)
Theme of Ceremony:
I prefer a Religious Ceremony
I prefer a Military Funeral Ceremony
I prefer a Non Religious Ceremony
I prefer a Lodge or Club Ceremony
I prefer (detail here):
Preferred Minister
Name
Telephone Number (with area code)
Readings
Scripture passages
Special poems
Other Readings
Flowers
The flowers I like are
Instead of flowers, I prefer donations to:
Music (To be played / sung at your service)
I prefer the following popular songs
I prefer the following hymns
I prefer the following musician(s) / vocalist(s)
I prefer just background music before and after ceremony
I prefer no music
Clothing, Jewelry, Eyeglasses, Mementos and Photographs
I prefer the following clothes be used
I prefer the following Jewelry be displayed
I prefer my eyeglasses be On Off
I prefer the following mementos be displayed
I prefer the following photographs be displayed
I have other preferences.
Items to be removed before final disposition
Items I want to keep with me
Memorial Cards or Folders
I prefer the smaller prayer card with a poem or religious prayer on the back I prefer the larger folder with a record of the service and poem or prayer inside
Casket Bearers
I prefer the following as my casket bearers:

Honorary Pallbearers (Optional)
I prefer the following as my honorary pallbearers:

Personal Wishes:

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