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Pre-Planning a funeral is becoming a common practice. More & more people recognize that planning a funeral in advance lessens the burden for those you love. It provides a personal peace of mind that everything is in order.

The subject of funerals is never an easy subject to discuss. Dealing with the death of a loved one means making major emotional and financial decisions in a limited amount of time. Family and friends are left to deal with numerous and necessary details that can leave loved one's feeling extremely overwhelmed. Exploring the many Pre-Planning options available and taking the time to Pre-Plan your funeral may be one of the kindest things you can do for those you love most.


Personal Information


First Name:
Middle Name(s):
Last Name:
Telephone Number:
E-mail Address:
 
 
Address:
Town/City:
State:
Zip Code:
Date of Birth:
Place of Birth:
(city&state or County & state)
Marital Status:
Spouses Name:
(Maiden name and full name of wife or husbandís full name)
Occupation:
(for longest period during working life)
Social Security Number:
Fatherís Full Name:
Motherís Full Name:
(include her madien name)

Person who will be in charge of my funeral arrangements:


Name: 
Address: 
Town/City: 
State: 
Zip Code: 
Telephone Number: 


Military Information


Branch of Service:
Description of Service:
(Wars fought in, medals earned, military campaigns)
Veteranís Service Number: 
Rank 
Location of Discharge Papers: 


Family Members


Spouse:
(Address and phone numbers)
Daughters:
(Hometowns and phone numbers)
Sons:
(Hometowns and phone pumbers)
Grandchildren:
(Hometowns and phone numbers)
Sisters:
(Hometowns and phone numbers)
Brothers:
(Hometowns and phone numbers)
Other Relatives:
(List relation, hometowns, and phone numbers)


My Funeral Service Preferences


Place of Service:
(Funeral Home, Church, Graveside, or other)

Clergy:
(Minister's hometown and phone number)


Type of Disposition: Burial
Entombment
Cremation
Other (Describe Below)


Cemetery Property Owned? Yes No
Name of Cemetery:
(Include: Location of Cemetery, City, & State)
Cemetery Preference:
(If property not owned, include location of cemetery, city & state)

Music Selections:
(Organ or piano background, live vocal,
or recorded music)
(If live vocal, include the vocalist,
and their phone number)
(List of songs)


Pallbearers or Honorary Pallbearers:
(Include pallbearers hometown, home phone number, and bearer type designation)
(A = Active Bearer, H = Honorary Bearer)


Lodge, Society, Fraternal Organization:
(List involvement and if you would
like an honor guard)


Flowers:

Memorial Contributions / Donations:

Obituary Information:

(List education and place of schooling, wedding date and place, work history and places I lived and worked, Clubs, Lodges, Hobbies, what I liked doing, significant accomplishments, Boards, Committees and community and Church involvement, etc.)



Any information or special instructions not previously listed:




Please check as many of the following as apply.


Please contact me so that I may select my casket and vault in advance.
Please forward me a copy of my information for my records.
Please contact me if any of my submitted information needs clarification.
File my information for future reference at VanKirk-Grisell Funeral Home, but please do not contact me.
I would like to discuss my pre-payment options with no obligation, please contact me.


607 Master Street, Corbin, Kentucky 40701-1057
Toll Free: (866) 528-3131   (606) 528-3131   Fax: (606) 523-5056

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