PRE-PLANNING FORM

A pre-planning information sheet follows. For your convenience, please feel free to provide us with the information that is typically necessary for the various legal and practical needs that arise following death. Once this information is received, we will keep it on file and send to you (or e-mail) a letter of confirmation.

If you wish, you may set up a FREE consultation with one of our licensed professional pre-planners to meet with you. Please call us at 303-743-8804. For an IMMEDIATE need, please call our hotline at 303-745-4418.

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Information about person completing the form:
I am Planning for:	Choose One Myself Spouse Life Partner Mother Father Child Friend Other Relative
Last Name:
First Name:
Middle Name:
E-mail:
Street Address:
City:
County:
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau
Zip Code:
Phone:
Hispanic Origin:	Yes No

Vital Information about the person you are planning for:
Last Name:
First Name:
Middle Name:
Sex:	Choose One Female Male
Marital Status:	Choose One Never Married Married Divorced Widow Widower
Social Security#:
Date of Birth:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31(ex. 1999)
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31(ex. 1999)
Father's Full Name:
Mother's Name:
Mother's Maiden Name:

Work and Education:
Education:	Primary 0 1 2 3 4 5 6 7 8 9 10 11 12 College 0 1 2 3 4 5+
Usual Occupation: (most of life)
Kind of Business:
Company (Optional):

Military Records:
Branch of Service:	Choose One Army Navy Air Force Marines Coast Gaurd Other
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers:   YES    NO
Name Of  Wars:

Funeral Service Information:
Service Options:	Traditional Burial Service Graveside Burial Service Immediate Burial Traditional Cremation Service Memorial Cremation Service Graveside Cremation Service Direct Cremation
Place Of Service:
Horan & McConaty Central Denver Chapel Horan & McConaty North Metro Chapel Horan & McConaty South Denver Chapel Horan & McConaty S.W. Denver/Lakewood Chapel Horan & McConaty South Metro Chapel Horan & McConaty S.E. Denver/Aurora Chapel
Church:
Religious Denomination:
Viewing for Family:	Yes No
Viewing for Friends:	Yes No
I Prefer	Cremation Burial
Name of Cemetery:
City:		State:
Grave or Niche Location:
Click for cremation options at Rocky Mountain Memorial Park.	Niche Placement Internment Scattering Held at Home
Favorite Bible Passages, Literature or Poems:

Person(s) To Finalize Arrangements At Time Of Death:
Check here and skip this section if is information is the same as person filling out this form
Full Name:
Street Address:
City:
County:
State:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau
Zip Code:
Phone:

Special Instructions:
Flower Preference:
Music
Casket Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:

Other Information & Special Instructions

Please list any other instruction or information you would like us to have:

Memorials & Charities

Please list any Memorials or Donations to Charity that you would like:

Options

Please select one of the options below: Send information about pre-arrangement Contact me to set an appointment Please keep my information on file

At Horan and McConaty, we take your right to confidentiality very seriously. We will not share information you submit to us with any person or entity outside of our company not legally entitled to receive it.

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