Preplanning On-Line

Thank you for considering our on-line preplanning option. We believe that preplanning is among the most important services we offer. Spending a little time and answering a few questions now will reduce the burdens on your family during a difficult time.

Complete as little or as much of the form as you feel is appropriate to your circumstances. Please contact us if you have any questions while you are completing the form. You can reach us at (708) 422-2700 or by email at info@curleyfuneralhome.com.


Please register your preplanning information and personal requests below.


Personal Information

First Name:
Middle Name(s):
Last Name:
Telephone Number:
E-mail Address:
 
 
Address:
Town/City:
State:
Zip Code:
Date of Birth:
Place of Birth:
(city&state or County & state)
Marital Status:
Spouses Name:
(Maiden name and full name of wife or husbandís full name)
Occupation:
(for longest period during working life)
Social Security Number:
Fatherís Full Name:
Motherís Full Name:
(include her madien name)

Person who will be in charge of my funeral arrangements:

Name:
Address:
Town/City:
State:
Zip Code:
Telephone Number:


Military Information

Branch of Service:
Description of Service:
(Wars fought in, medals earned, military campaigns)
Veteranís Service Number:
Rank:
Location of Discharge Papers:


Family Members

Spouse:
(Address and phone numbers)
Daughters:
(Hometowns and phone numbers)
Sons:
(Hometowns and phone pumbers)
Grandchildren:
(Hometowns and phone numbers)
Sisters:
(Hometowns and phone numbers)
Brothers:
(Hometowns and phone numbers)
Other Relatives:
(List relation, hometowns, and phone numbers)


My Funeral Service Preferences

Place of Service:
(Funeral Home, Church, Graveside, or other)

Clergy:
(Minister's hometown and phone number)


Type of Disposition: Burial
Entombment
Cremation
Other (Describe Below)


Cemetery Property Owned? Yes No
Name of Cemetery:
(Include: Location of Cemetery, City, & State)
Cemetery Preference:
(If property not owned, include location of cemetery, city & state)
Music Selections:
(Organ or piano background, live vocal,
or recorded music)
(If live vocal, include the vocalist,
and their phone number)
(List of songs)


Pallbearers or Honorary Pallbearers:
(Include pallbearers hometown, home phone number, and bearer type designation)
(A = Active Bearer, H = Honorary Bearer)


 
Lodge, Society, Fraternal Organization:
(List involvement and if you would
like an honor guard)


Flowers:

Memorial Contributions / Donations:

Obituary Information:

(List education and place of schooling, wedding date and place, work history and places I lived and worked, Clubs, Lodges, Hobbies, what I liked doing, significant accomplishments, Boards, Committees and community and Church involvement, etc.)



Any information or special instructions not previously listed:




Please check as many of the following as apply.

Please contact me so that I may select my casket and vault in advance.
Please forward me a copy of my information for my records.
Please contact me if any of my submitted information needs clarification.
File my information for future reference at Curley Funeral Home, but please do not contact me.
I would like to discuss my pre-payment options with no obligation, please contact me.


In Association with T. P. Kerrigan Funeral Directors

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