Golden Gate Funeral and Cremation Services (816) 255-3676MEMORIAL PLANNING GUIDEThe following planning guide is for: First Last My favorite hobby is:I want to be remembered for:Vital Statistics Information, Gender:Date of Birth:01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearPlace of Birth (City, State): CityState / Province / RegionCurrent Address (Street, City, State, Zip Code): Street AddressCityState / Province / RegionNr. of Years at current:Previous Address(s) (Street, City, State, Zip Code): Street AddressCityState / Province / RegionPostal / Zip CodeNr. of Years at previous:Home Phone: Area Code - Phone Number Daytime Phone: Area Code - Phone Number Cell Phone: Area Code - Phone Number E-mail:Veterans Information:Are you a vet?:yesnoBranch:Rate or Rank:Service Number:Enlistment Date:Discharge Date:Biographical Information:Spouse's Name: First Last Marriage Date:Place of Marriage: Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryDate of Death:Lifetime Occupation:Industry:Employer:High School Attended:City, State: CityState / Province / RegionYear Graduated:College Attended:City State: CityState / Province / RegionYear / Graduated:Father's Name: First Last Mother's Name (including Maiden Name): First Last 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?yesnoName: First Last Address, City, State: Street AddressCityState / Province / RegionDo you have a will? If so, please provide a copy or the location of the willAttorney Name First Last Address: Street AddressCityState / Province / RegionPhone: Area Code - Phone Number Executor of Estate Name First Last Address : Street AddressCityState / Province / RegionPhone : Area Code - Phone Number Funeral Service Information:Funeral Home Name:Funeral Address: Street AddressCityState / Province / RegionPhone #: Area Code - Phone Number Service Type and Location:Participating Organizations (Fraternal, Military):Officiant Name First Last Cemetery NameIs a marker installed at your plot?yesnoMusic, 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: First Last Authorized Date:SubmitReset