1. Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

About You

Email Address

Phone Number

Your Private Key

The following key allows you to continue filling out this form later. We are also going to send it to you by email.

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2. Family, Work, & Education

Family Information

Father's Name

Father's Address

Mother's Name

Mother's Address

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great Grandchildren (alive)

Great grandchildren (deceased)

Education History

Highest level of education

School Name

School Location

Work History

Occupation

Company Name

Years at Company

Did this person serve in the military?

Yes No

Branch of Service

Years served

4. Your Preferences

Please list any musical selections you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any interests or hobbies you would like to include into your services.

Please list any special themes you would like to include in your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Rose & Graham Funeral Home Inc.

Make these important decisions in the privacy of your own home with our simple online pre-planning form.

1. Personal Information

Who is this plan for?

About You

Your Private Key

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2. Family, Work, & Education

Family Information

Additional Family Members

Education History

Work History

Did this person serve in the military?

3. Your Wishes

Visitation Options

Funeral Service Options

Reception Options

Would you prefer burial or cremation?

Final Disposition

Would you prefer to include a graveside/committal service?

4. Your Preferences