Header Information

 

TEL: (816) 231-GATE

(816) 255-3676

2800 East 18th Street, Kansas City, MO 64127

info@kcgoldengate.com 

Fax: 816-569-4889

Golden Gate Funeral and Cremation Services  (816) 255-3676

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 at previous:
Home Phone:
-
Daytime Phone:
-
Cell Phone:
-
E-mail:

Veterans Information:

Are you a vet?:
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?
Name:
Address, City, State:
Do you have a will? If so, please provide a copy or the location of the will
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?
Music, Special Readings, Scripture, Poetry (include reader/musician name and phone):
Other Requests (Flowers, Clothing):
Jewelry or Glasses:
Pall Bearers:
Special Instructions, Notes:
Memorial Contribution Designation:
Authorized by:
Authorized Date: