Mueller Funeral Home - Online Pre-Planning Form

Personal Info

Personal Information

Full Name *

Maiden Name

Address *

City / Village / Town *

State *

Zip Code *

Phone Number *

Date of Birth *

Birthplace

Father's Name

Mother's Name

Mother's Maiden Name

Education

Marital Status *

Married to Whom (Spouses Maiden Name)

Date & Place of Marriage

Military Info

Military Information

If Veteran, Name of War

Branch of Service

Rank

Date Enlisted

Date Discharged

Service Serial Number

Misc. Info.

Misc. Information

Employment History

Church Affliliation

Clubs & Organizations

Hobbies & Activities

Special Achievements or Recognition

Other Obituary Information

Surviving Relatives (Names, Relationship to You, Spouses, and Where They Reside)

Relatives Preceded In Death (Names & Relationship to You)

Funeral Preferences

Funeral Service Preferences

Place of Service

Officiating Clergy

Scripture or Other Readings

Musical Selections

Organist / Vocalist / Other Musicians

Active Pallbearers

Honorary Pallbearers

Visitation Place and Any Other Requests

Memorial Funds

Flowers (Type & Colors)

Instructions For Clothing, Jewelry, Etc.

Name & Location of Cemetary (Lot, Section, Grave)

Monument / Marker

Newspapers Obituary Is To Be Published In

Other Instructions or Requests

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Funeral Pre-Planning Form