Pre-Planning Worksheet

In order for us to serve you better, please fill in the following information:

Name (First MI Last):
Sex		Marital Status
Date of Birth:		Place Of Birth:
Address:
City:	State: Zip:
Phone:	Your Email:
Spouse's Name:	Spouse's Maiden Name:
Place of Marriage:	Date of Marriage:
Father's Name:	Mother's Name:
Mother's Maiden Name:

**Work/Education History**
Education Level:	Primary:
Education Level:	Secondary:
Occupation:
Business:		Industry:
Company:		Number Of Years:

**Military Service**
Service Branch:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Discharged:		Discharge On File At:
Name Of Wars:

**Funeral Preferences**
I Prefer My Funeral Service To Be
Place Of Service:
Conclude Service At:
Religious Denomination:
Place Of Worship:
	Name:
I Prefer
Type Of Clothing:
Preferred Casket Type:
Vehicle For Family

**Memorialization Instructions**
Musical Selections To Be Played
Will Supply CD/Tape
Musical Selections To Be Sung
Favorite Bible Passages:
Favorite Literature Or Poems:
Favorite Flower(s):
Favorite Flower Color:

**Final Disposition**
Preference for final disposition is:	Ground interment with
	Mausoleum entombment
	Cremation with
Cemetery Name:
Address:
A is owned at the above location

Hartman Funeral Home
1801 Delaware Ave.
McComb, Ms. 39648
601-684-3811