Nelson Funeral Home Pre-Planning Form

     Please indicate which location:  Nelson Funeral Home, Chicago

                                                                Nelson Funeral Home, Park Ridge

First Name: Middle: Last Name:

Address: City:

State:   Zip:

Male Female Birthplace: Birthdate:

Home Phone: Other phone:

Mother's Maiden Name:

Father's Name:

Marital Status:   Married    Never Married    Widowed    Divorced

Spouse Name (include maiden): Years married:

Education and Employment History

Highest grade completed: College List No. of years:

Schools attended:

Occupation: Type of business:

Place of employment:

Years: Date of Retirement:

Military Service

Veteran ? Yes No      Branch:  Army Navy Marines Air Force Coast Guard

Period: WWII Korea Vietnam Desert Storm Peace Time Other:

Date entered: Date Discharged:

Rank:

Service Number: Copy of Discharge Available ? Yes  No

Do you wish to have an honor guard present at committal services? Yes  No

List of Survivors

Spouse: Parents:

Children: Please list spouses, if applicable.

Grandchildren:

Great-Grandchildren:

Brothers and/or Sisters:

Other Survivors:

Preceded in death by:

Organizations, Clubs:

Hobbies, Interests, Events, Awards:

Memorials Designated to: (may or may not include address or web address)

Newspaper(s) for Death Notice or Obituaries:

Chicago Tribune Chicago Sun-Times Daily Herald

Other

                                                    

Type of Service to be Provided

Traditional Funeral: Visitation for one day; Funeral ceremony the next day at your church or at

the Nelson Funeral Home; Burial, Entombment or Cremation to Follow.

 

Visitation and Ceremony on the same day.

 

Memorial Gathering, Memorial Service or Life Celebration at Nelson Funeral Home or other location.

      This may be preceded by burial or cremation.

 

Direct Cremation or Burial with no viewing or ceremony

Other Type of Service:

Visitation held at: Nelson Funeral Home, Chicago  

Nelson Funeral Home, Park Ridge

Funeral, Memorial Gathering, Memorial Mass, to be held at:

Religious or Church affiliation:

Clergy name: Phone:

Note: If no clergy is available to you, we have can contact several local ministers of different religious

denominations who we can contact for you. They are chosen for their expertise in conducting a

fitting and meaningful tribute.

 

Special Music: (This may include for use during visitation in the background.) If there are special

songs to include during the ceremony, this is relayed to either the Service Planner at the Church,

the Officiating Minister/Priest or to us.

 

Cemetery Information

 

Burial     Cremation  Entombment   Is a gravesite already purchased? Yes  No

 

Cemetery: City:

Section: Block: Lot: Grave:

Previous Burial(s):

 

If Cremation is chosen, where will cremated remains be:

Above Cemetery    At Home Other Undecided

 

Additional Requests and Information

 

 

 

Your Information

 

First Name: Last Name:

Address: (Optional)

Phone contact (Optional): email

Would like us to contact you for further information? Yes  Not at this time

 

You may print this form for your records. Should you desire, you may send it directly to us

by clicking the SUBMIT FORM button.      RESET FORM will erase any information you have

provided.