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Ballard Funeral Home
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Ballard Funeral Home.
*Require fields

Person Completing this Form*:
Relationship*:
Email*:
 
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
Address:
(no P.O. Box)
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran: Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
 
Family Member Information

Family Member #1

 
Funeral Arrangement Details
Person in charge of arrangements:
 
Place of service or gathering:
If Other, please specify:

 

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:
 

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?

 

Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

  security code
Enter Security Code:

 
Sharon Dillard
Born: 1/17/1948
Died: 7/20/2017
Manuel Gonzales Jr
Born: 8/29/1942
Died: 7/19/2017
Jose Lara
Born: 3/18/1968
Died: 7/15/2017
James Berg
Born: 8/13/1952
Died: 7/15/2017
Joseph Romero
Born: 7/8/1948
Died: 7/12/2017
Betty Beatty
Born: 5/20/1929
Died: 7/12/2017
Shelly Seely
Born: 4/3/1958
Died: 7/12/2017
Ben Adams Jr.
Born: 1/8/1942
Died: 7/10/2017
Robert Valdez
Born: 12/16/1934
Died: 7/6/2017

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