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Family Owned. Family Focused.

1-610-750-5057

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Home
Cremation Forms
Urns and Jewelry
- Urns
- Finger Print Jewelry
Obituaries
About Us
Location
Questions

Pre-Arrangement Form - Use this form prior to someone passing.

Use this form to provide us with as much as you can regarding the person who the pre-arrangement is for. All of the questions asked are used for legal forms such as the death certificate.

Pre-Arrangement Details

Personal Information

Full Name of person who the pre-arrangements are for.

Street

City

State/Province

ZIP/Postcode

Date of Birth

Social Security Number

Place of Birth (City/Town, State)

Marital Status

Spouse's Name

Spouse's Maiden Name

Father's Name

Mother's Name

Mother's Maiden Name

Self Described Race

WhiteAfrican AmericanOther

Of Hispanic Origin?

NoHispanicPuerto RicanMexicanOtherUnknown

Work/Education History

Education Level

Grade-School

High-School

Some College

Associate's Degree

Bachelor's Degree

Masters-Degree

Doctorate

Occupation (Job title for most of working career) Do Not use Retired

Company Name (Company worked for longest)

Business Field (Manufacturing, Service, etc.)

Military Record

Military Service?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Do you have a copy of the discharge papers?

YesNo

Family Member in Charge

Name of Person Legally in charge of Cremation Arrangements

Relationship to Person these pre-arrangements are for

Street address of Person in Charge

City / State / Zip

Person in Charge Telephone and Email Address

How may Certified Copies of the Death Certificate do you Need? The State charges $ 20. per copy.

Do you want a Funeral Director to call you?

Yes, please have a Funeral Director call to arrange a time so I can pre pay these services.

No, please do not call me Just simply keep my information on file.

Obituary (Optional) The Reading Eagle charges a minimum of $ 400 per obituary

Mark A. McCarter, Supervisor