Office: (270) 343-3483

202 N. Main St.
Jamestown, KY 42629

Pre-planning

Today, more than ever, families are taking important steps to pre-plan their funerals because of the many important advantages that pre-planning offers. Pre-planning can be thought of as an act of love and kindness, since it relieves survivors from the tasks of having to make difficult decisions during an emotional and stressful time. Pre-planning also helps to make your choices known to your survivors, rather than having your family guess what your wishes may be. Pre-planned arrangements are flexible and may be updated or changed in future years.

Pre-planning offers important financial advantages as well. Although pre-payment is not required, a pre-payment allows you to secure costs of today, and protect against inflation. Pre-payment alleviates the survivor's financial burden. It also allows the family to protect their assets, if state assistance is needed in future years. Today, pre-planning is an essential part of personal, financial and estate planning.

The online pre-planning form below was designed to allow us to gather basic information about you and your desired funeral service.

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 husband’s full name)
Occupation: (for longest period during working life)
Social Security Number:
Father's Full Name:
Mother's Full Name: (include her maiden name)
Person who will be in charge of my funeral arrangements:
Name:
Address:
Town/City:
State:
Zip:
Telephone Number:
Military Information
Branch of Service:
Description of Service: (Wars fought in, medals earned, military campaigns)
Veteran's 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 H. E. Pruitt Memory Chapel, but please do not contact me.
I would like to discuss my pre-payment options with no obligation, please contact me.

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