Prearranging Form

The O’Connell Family Funeral Homes have prepared the following questions to assist you with the pre-planning process. These are some of the basic biographical and informational questions that would come up when making arrangements.

You can fill out this form and print it for your records and also keep a copy with us by hitting the Submit button.
All the information will remain STRICTLY confidential. **This form does not ask for the individual’s social security number, however when meeting with a funeral director, either for pre-arrangements or at-need arrangements, we will need this bit of information.

Full Name (required):

Street Address:

City:

State:

Zip:

Phone:

Date of Birth:

Place of Birth:

Father's complete name:

Mother's complete name:

Maiden name:

Place of elementary education:

Place of high school education:

Place of college education:

Degree Obtained:

Main occupation during life:

Primary employer:

Spouse's complete name:

Maiden name:

Date of marriage:

Place of marriage:

Church denomination:

Location of church:

Type of service selected:

Cemetery location:

Interests, Hobbies, and Organizations

Are you a veteran?YesNo

Next of kin:

Special instructions or notes to the O'Connells:

Do you wish to be contacted by phone or e-mail?YesNo
Your Email (required)

Can we send you a free no obligation advanced
planning guide?YesNo

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