Pre-Arrangement Plans

(this form also available in .pdf format)  

Please use the following online pre-arrangement guide to help you plan for the inevitable. It is not necessary to fill in all blanks, nor is it necessary to send it to us. You may choose to simply PRINT the form and keep it for your own records. 

Pre-Need Arrangements

J.T. Anderson Funeral Home, Inc.

205 College Avenue

Beaver, PA  15009

 

Fax: (724) 774-2940

The information asked for is typical of most funeral home requests and some of it is not. Some of these questions would be for the obituary while others would be mandatory statistical information for completion of Pennsylvania Death Certificate.

Memorial Videos are offered by some funeral homes while others are still unable to offer this service.  If your funeral home does not offer it, please feel free to contact us for pricing. Our Videos come standard with all of our funeral packages except for the Basic.

 

Last Name

First Name

Middle Name

Maiden Name

Marital Status

Gender

 

Current Residence

Street Address

City

State

Zip

County

Township

Phone

Email

 

Birth & Marriage Information
Date of Birth City & State of Birth
Mother's Name Mother's Maiden Name
Father's Name City & State of Marriage
Spouse's Name Spouse's Maiden Name
Date of Marriage    

 

Children
Name Marital Status Spouse's Name

# of Children

 

Occupation

Kind of work done during most of working life- Do not state Retired. 

Kind of Business/Industry 

 

Education
Elementary/Secondary (0-12)     College 

 

Military Service

Ever serve in U.S. Armed Forces     Service No.

Enlistment Date

Discharge Date

Rank when discharged    

 Do you have a copy of your discharge papers? 

Discharge on file at

   Wars Served In

Funeral Plans

I would prefer a  

Place of Service
With Visitation Services at

Religious Preference

My Church is

 and I would like   to officiate.
I already have burial/entombment arrangments at
Pall Bearers

 

Other Special Requests

 

I would like to be contacted  YES  NO                 Please contact me by Mail  

Email  Phone

The best time to contact me is between  &

   

© J.T. Anderson Funeral Home, Inc., Beaver, PA  2008

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