Prearrangement Form

Carlson-Becker Funeral Home

106 N. 2nd

Hope, KS 67451

785-366-7327

Map and Directions

Martin-Becker-Carlson Funeral Home

414 NW 3rd Street

Abilene, KS 67410

785-263-1414

Map and Directions

Carlson-Becker Funeral Home

208 West 4th Street

Solomon, KS 67480

785-655-3431

Map and Directions

	Prearrangement Form
	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 # _____

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 [ ]