Preplanning

Personal Details
First Name	>
Middle Name	>
Last Name	>

Email Address	>
Daytime Phone Number
Evening Phone Number

Street Address
Mailing Address	Same as street address, or
City
Province
Postal Code

Date of Birth	, e.g. August 17, 1956
City of Birth
If rural, Land Numbers
Province of Birth
Country of Birth

Sex
Marital Status
Social Insurance Number
Occupation
Industry
Veteran
If so, DVA Regimental Number

Spouse's Name
Spouse's Maiden Name
Mother's Name
Mother's Maiden Name
Mother's Birthplace
Father's Name
Father's Birthplace
Father's Last Name

Funeral Service Information
Type of Funeral Service
Place of Service
Name of Church
Religious Denomination
Viewing for Family
Viewing for Friends
Name of Cemetery
Cemetery City
Plot Location Numbers (if known)
Confirm Memorialization for Cremation
Reception Following Services

Favourite Musical Selections - up to 4 may be entered - use as much text as you wish
Favourite Bible Passages, Literature, Poems or Readings - up to 4 may be entered - use as much text as you wish

Special Instructions and Requests

My Executor, Family Member or Close Friend to Finalize Arrangements at Time of Death
Name
Relationship
Address
City
Province/State
Daytime Phone
Evening Phone
Options	Please call me to arrange an interview Please keep all my information on file

Please let your executor, family member or close friend know that this information is on file with us.