[Note: Print this information out, copy, and use during the pre-funeral interview with the family.]
DATA FOR THE MEMORIAL SERVICE OF:
Name_________________________________________________
Address_______________________________________________
Place of Birth__________________________________________
Date of Birth___________________________________________
Place of Death__________________________________________
Date of Death_____________________________ Age_________
Cause of Death_________________________________________
Parents:
Father______________________________________________
Mother_____________________________________________
Marriage:
Spouse______________________________________________
Date________________________________________________
Place_______________________________________________
Family: Location:
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
_________________________ _______________________
____________Grandchildren ____________Great grandchildren
Educational Background:
High School: ________________________ Year: ___________
College: ___________________________ ___________
___________________________ ___________
Church Affiliation: ______________________________________
Social/Civic/Lodges:
_____________________________________________________ _____________________________________________________ _____________________________________________________
Hobbies/Personal Interests:
_____________________________________________________ _____________________________________________________ _____________________________________________________
Characteristics & Qualities of Deceased:
_____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________
Place of Service:
_____________________________________________________
Date and Time:
_____________________________________________________
Funeral Home & Director in Charge
_____________________________________________________
Interment:
_____________________________________________________
Musicians:
Organist_____________________________________________
Soloist______________________________________________
Order of Service (provide copy for Funeral Home/Musicians)
_____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________
Favorite Scripture(s):
_____________________________________________________
Favorite Song(s):
_____________________________________________________
Poem(s)/Reading(s):
_____________________________________________________
Other Participants in Service:
_____________________________________________________
Other Pertinent Information:
_____________________________________________________ _____________________________________________________ _____________________________________________________