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Loran Fawcett Chapel
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Loran Fawcett Chapel.
*Require fields

Person Completing this Form*:
Relationship*:
Email*:
 
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
Address:
(no P.O. Box)
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran: Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
 
Family Member Information

Family Member #1

 
Funeral Arrangement Details
Person in charge of arrangements:
 
Place of service or gathering:
If Other, please specify:

 

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:
 

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?

 

Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

  security code
Enter Security Code:

 
Keith Woldum
Born: 2/28/2007
Died: 5/2/2017
Patricia Barrett
Born: 5/8/1954
Died: 4/27/2017
Kelly Glasgow
Born: 1/15/1988
Died: 4/26/2017
Jack Greer
Born: 3/29/1920
Died: 4/16/2017
Joyce Norris
Born: 7/15/1939
Died: 4/5/2017
Bree Reynolds
Born: 10/11/2000
Died: 3/23/2017
DeWayne Prosser
Born: 6/7/1948
Died: 3/9/2017
Travis Baird
Born: 9/24/1969
Died: 2/17/2017
James Brewer
Born: 6/27/1949
Died: 2/10/2017

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Loran Fawcett Chapel | 704 Indiana | Neodesha, KS 66757 | 620-325-3038
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