Crestview Memorial
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Pre-Planning Form
I am planning for:
Myself
My Spouse
My Mother
My Father
My Child
My Friend
Other
Personal Information
Name:
Email Address:
Address:
City:
State/Province:
Country::
Zip Code:
Phone Number:
Place of Birth:
Date of Birth:
Sex:
Male
Female
Citizenship:
Marital Status:
Married
Widowed
Never Married
Divorced
Spouse (Maiden Name):
Father's Name:
Mother's Maiden Name:
SSN:
Religous Preference:
Education
High School Name:
# of Years:
College Name:
Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)
Survivors:
Preceded in Death by::
Additional Information and Organ:
Work History
Occupation:
Business:
Industry:
Company:
Number of Years:
Years Retired:
Military Service
Service Branch:
Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge on File At:
Combat Action:
Funeral Preferences
I prefer my Funeral Service to be
Public:
Private:
Visitation
Public:
Private:
Place of Service:
Chapel
Cemetery
Church
Other
Other:
I prefer
Cremation:
Burial:
Entombment:
For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.
Crestview Memorial Funeral Home
492 East PineAve.
Crestview, FL 32539
850-682-2252
Liveoak Park Memorial Cemetery
112 North Ave East
Crestview FL 32536
850-682-3813