New Leaf Grief Resources E-Magazine













           

Prearrangement

Prearranging your funeral in advance allows you to select exactly what services and funeral merchandise are appropriate for you. This offers you the peace of mind of knowing that your wishes will be carried out, and relieves your loved ones of the responsibility of making the decisions at the time of your death.

Personal Information

First Name:
Last Name:
Middle Name:
Email:
Address:
City:
Country:
State:
Zip Code:
Phone:
 

Vital Statistics

Marital Status:
Social Security No:
Date of Birth: EX: 10/2/1920
Place of Birth:
Spouce's Name:
Father's Name:
Mother's Name:
Mother's Maiden Name:
 

Work/Education

Education (0-12):
Education (1-5+):
Occupation:
 

Military Record

Branch of Service:
Serial Number:
Date Enlisted: EX: 10/2/1920
Date of Discharge: EX: 10/2/1920
Rank at Discharge:
 

Funeral Service Info

Place of Service:
Place of Visitation:
Religious Denomination:
Place of Worship:
 

Special Instructions

Flower Preference:
Music:
Casket Bearers (6):





Clothing:
 

Disposition Request

I Prefer:
Cemetery:
I Have a Will?
 

Memorials/Donation

Please List:
 

Other Instructions

Please List:

Contact Options

Please Select One:

 
 
 
 
© 2009 Marcy Funeral Home • 208 Liberty Street • Conneaut, OH 44030 • 440.593.4253

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lake sunset photo taken by Ken Rowe.