Plan Ahead Form - Golden Gate Funeral LLC

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Golden Gate Funeral and Cremation Services (816) 974-0627

MEMORIAL PLANNING GUIDE

The following planning guide is for:

My favorite hobby is:

I want to be remembered for:

Vital Statistics Information, Gender:

Date of Birth:

Place of Birth (City, State):

Current Address (Street, City, State, Zip Code):

Nr. of Years at current:

Previous Address(s) (Street, City, State, Zip Code):

Nr. of Years previous:

Home Phone:

Daytime Phone:

Cell Phone:

Email

Veterans Information:

Are you a vet?

yes no

Branch:

Rate or Rank:

Service Number:

Enlistment Date:

Discharge Date:

Biographical Information:

Spouse's Name:

Marriage Date:

Place of Marriage:

Date of Death:

Lifetime Occupation:

Industry:

Employer:

High School Attended:

City, State:

Year Graduated:

College Attended:

City, State:

Year / Graduated:

Father's Name:

Mother's Name (including Maiden Name)

Church, Memberships, Offices, Affiliations:

Name of Newspaper for Obituary:

Surviving Relations Information (Name, Address, Phone of Father, Mother Children):

Surviving Relations Information (Name, Address, Phone of brothers and sisters):

Preceded in Death By (Name and Relation):

Legal Information:

Do you have a durable power of attorney for health care decisions?

yes no

Name:

Address, City, State:

Do you have a will? If so, please provide a copy or the location of the will

yes no

If yes provide either the location of the will...

OR a copy

Attorney Name:

Address:

Phone:

Executor of Estate Name:

Address:

Phone:

Funeral Service Information:

Funeral Home Name:

Funeral Address:

Phone:

Service Type and Location:

Participating Organizations (Fraternal, Military):

Officiant Name:

Cemetery Name:

Is a marker installed at your plot?

Yes No

Music, Special Readings, Scripture, Poetry (include reader/musician name and phone):

Other Requests (Flowers, Clothing):

Jewelry or Glasses:

To be worn? To be returned?

Pall Bearers:

Special Instructions, Notes:

Memorial Contribution Designation:

Authorized by:

Authorized Date: