Pre-Planning Worksheet

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Information about person completing the form:
I am Planning for:
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
State:
Zip Code:
Phone:

Personal history of the person you are planning for:
Legal Last Name:
Legal First Name:
Legal Middle Name:
Sex:
Marital Status:
Social Security#:
Date of Birth:	(ex. 1999)
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:
Education:
Primary Occupation:
Kind of Business:

Military Records:
Branch of Service:
Copy of Discharge Papers: YES NO

Memorial Wishes
Type of Service:
Location of Service:
Visitation to be Held At:
Preferred Clergy:
Clergy's Church Association:
Special Ceremonies:
Casket:
Urn:
Newspaper Obituaries:

Choice of Disposition:
I Prefer:
Cemetery:
Cemetery Lot Description:
Existing Grave Marker:	YES NO
Marker Date Completion Needed:	YES NO

Person Making Final Arrangements At Time Of Death:
Check here and skip this section if information is the same as person filling out this form

Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:

Other Information & Special Instructions
Please list any other information you would like us to have:

Memorial Contributions
Please list any Memorials or Donations to Charity that you would like:

Please select one of the options below:

Send information about pre-arrangement

Contact me to set an appointment

Please keep my information on file

Cook Funeral Home & Cremation Services • 4235 Prairie St. SW Grandville, MI 49418 • 1-866-500-COOK

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