Williamson Funeral Homes, Ltd.

Pre-Arrangements

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you’d like us to work with you on the remaining information using the options at the base of the form.

Staunton & Worden chapels · Call 618-635-2442

Full Name

Street

City

State / Province

ZIP / Postcode

Telephone

Date of Birth

SSN # Mock-up only — do not enter a real Social Security number.

Place of Birth

Father’s Name

Mother’s Name

Mother’s Maiden Name

Marital Status

Spouse’s Name

Place of Marriage

Spouse’s Maiden Name

Date of Marriage

Additional Surviving Family Members Siblings, children, grandchildren — living or preceded.

Education Level

Occupation

Company Name

Business Field

Did you serve?

Yes No

Branch

Date Entered

Date Discharged

Serial Number

Rank at Discharge

Discharge on file at

Copy of discharge papers?

Yes No

Wars Fought In

Person in Charge

Address

Telephone

Place of Service

Place of Service Telephone

Place of Visitation

Religious Denomination

Place of Worship

Lodge / Union / Assoc. Membership

Person in charge of final arrangements

I Prefer

Cemetery

Lot #

Section / Letter

Grave #

Cemetery Address

Cemetery Telephone

Last will and testament?

Yes No

Location of Will

Additional instructions

Memorial requests / donations

Contact preference

Send me information about pre-arrangements Contact me to set up an appointment No appointment needed — just keep my request and information on file

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