Downing & Lahey • Mortuary – Crematory • Preneed Planning • Online Pre-Planning Form

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This planning form walks you through the entire pre-planning process, so it’s easy to gather information and make appropriate funeral selections. You can create and save a plan to be retrieved at any time.

Please feel free to provide us with this information and we will keep it in a confidential file.

If you wish to visit with us regarding your planning needs, feel free to call us (316) 682-4553 or send an e-mail to preneed@downingandlahey.com.

PERSONAL INFORMATION
* Last Name:
* First Name:
Middle Name:
Address:
City:
Country:
State:
Zip Code:
Phone:
* E-mail:

VITAL STATISTICS
Marital Status: Married, Divorced, Single
Date of Birth:
Social Security No.:
Spouse’s Name:
Spouse’s Maiden Name:
Date of Marriage:
Place of Marriage:
Father’s Name:
Mother’s Maiden Name:
Family Ancestry:

WORK/EDUCATION
Education (K-12):
College: Undergraduate, Graduate, Post-Graduate
Occupation:
Business:
Type of Industry:
Number of Years:

MILITARY RECORD
Branch of Service:
Serial Number:
Date Enlisted:
Date Discharged:
Rank at Discharge:
Discharge on File at:
Copy of Discharge Papers:	Yes/No
Veteran of which wars?

FUNERAL SERVICE INFORMATION
Disposition Preference:	Burial, Cremation
Place of Service:
Preferred Cemetery:
Location:
Property Owned:	Yes/No
Description:
Marker Installed:
Outer Burial Container:
Officiant:
Church/Organization:
Music (Organist/Vocalist/CD or Tape):
Music Selections (Fields for 1-4):
I will supply CD or Tape:	Yes/No
Favorite Bible Passages:
Favorite Literature or Poems:
Favorite Flowers:
Jewelry:	Yes/No
Glasses:	Yes/No
Clothing:
Special Instructions:
Lodge/Union:
Casket Bearers:

OTHER INSTRUCTIONS
Please list any other instructions you may have:

MEMORIALS/DONATIONS
Please list any Memorials or Donations to Charity that you would like:

PERSON TO FINALIZE ARRANGEMENTS
Name:
Relationship to deceased:
Address:
City:
State:
Zip Code:
Phone:
E-mail:

OPTIONS

Please select one of the following options:

Send information about Choices^SM Preneed Planning.
Contact me for a meeting.
Please keep my information on file.