Panebaker Funeral Home

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Information about whom this plan is for

First Name

Middle Name

Last Name

Gender

Female

Male

Your Information

First Name

Middle Name

Last Name

Daytime Phone

Evening Phone

Password

I would like to be contacted to discuss this Pre-Planning Form

Yes

Biographical Information

Birth Date

Birth Place

Family Information

Marital Status

Married

Single

Widowed

Divorced

Name of Spouse

Marriage Date

Maiden Name of Spouse

If deceased, date of death

Father's Name

Address - If Living

City

State

Zip/Postal Code

Mother's Name

Address - If Living

City

State

Zip/Postal Code

Siblings (Living)

Siblings (Deceased)

Children (Living)

Children (Deceased)

Grandchildren (Living)

Grandchildren (Deceased)

Great Grandchildren (Living)

Great Grandchildren (Deceased)

Education & Work

Highest Level of Education

School Name

School Location

Occupation

Company

Military Service

Yes

Branch of Service

Years Served

Visitation Options

Visitation at funeral home.

Visitation at:

I do not wish to have visitation hours.

Funeral Service Options

Funeral service at funeral home.

Funeral service at:

I do not wish to have a funeral service.

Reception Options

Reception at funeral home.

Reception at:

I do not wish to have a reception.

Would you prefer burial or cremation

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

Please list any musical selections you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any interests or hobbies you would like to include into your services.

Please list any special themes you would like to include in your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Plan Ahead

Online Pre-Planning Form