Martin Becker Carlson Funeral Home                                         Carlson Becker Funeral Home

Personal Wishes and Desires

This is information families never discuss-- especially the
children. But yet, if something had happened to you last
night, these are the questions your funeral director would be asking your family today.

Would you have had your service:
__ At the funeral home  __The church  ___ Other
What is the name of your church _____________________
Who's your favorite minister, priest, or rabbi?__________
Are there any readings or scriptures that are special to you?
________________________________________________
________________________________________________
Many people have a favorite song or hymn. What's yours?
________________________________________________
Some families prefer a memorial donation instead of flowers.
What is your feeling? 
___ Memorial Donation    ___ Flowers   ___ Both
What clothing would you prefer? _____________________
________________________________________________
Would you like to wear jewelry? _____ Yes _____ No
To be removed? _____ Yes  ______ No
Would you like to wear you eyeglasses? ____ Yes ____ No
Do you have a cemetery property? _____ Yes   _____ No
________________________________________________
Name and location of cemetery                    Lot #      Space#

Most families prefer to have friends, neighbors, or relatives as active or honorary pallbearers.  Who would you prefer?
Active pallbearers (name and telephone#)
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Honorary pallbearers (name and telephone #)
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

Good Samaritans
This is where we list closest friends in the event your family needs help at the time of need by: Notifying friends, handling sympathetic phone calls, running errands, helping out-of-town guest.
1. ______________________________________________
2. ______________________________________________
3. ______________________________________________
4. ______________________________________________

PREFERRED SERVICE TYPE
Traditional full service for burial or entombment [ ]
Immediate burial with memorial service [ ]
Graveside service only [ ]
Immediate burial with no ceremonies or visitation [ ]
Traditional full service followed by cremation [ ]
Traditional cremation service with rental casket [ ]
Memorial service with cremation [ ]
Private family viewing with cremation [ ]
Immediate cremation [ ]


_______________________________       __________
Signature                                                            Date

Historical Record                                                                                                 
Name__________________________________________
Address________________________________________
City ________________ County ___________ State ____
Zip code _________ Tele # _________ Education ______
Birth Date:____________________   Age ____________
Birthplace: City _____________ County______________
Occupation (Previous if retired) _____________________
Employer (Or retired from) ________________________
Martial Status: Single__ Married__ Widowed__ Divorced__
Spouse Name ___________________________________
Maiden Name __________________________________
Date of Marriage ________________________________
Place of Marriage________________________________
In State Since ______ In City Since _________________
Moved from ____________________________________
Social Security Number ___________________________
Name of Father _________________________________
Date of deceased __________ Birthplace _____________
Name of Mother (Maiden)_________________________
Date of deceased __________ Birthplace_____________

Veteran Information
Name of War ________________Service # ___________
Branch of Service________________________________
Place Inducted________________ Date ______________
Place Discharged _____________  Date ______________
Rank/Rate when discharged________________________
Discharged Papers located _________________________
Flag to drape casket:  _____ Yes   _____ No

Names of Children
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________

Brothers & Sisters
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________
Name _________________________________________
Address _____________________ Tele # _____________