Pre-Planning Form - Schlossberg Chapel

Please complete the form below and click the “submit” button to email the information to us. We will maintain a copy of your confidential arrangement information in our files, and will provide a copy to you for your records.

Please take the time to be sure that this information is accurate. Once the information is filed, amending a filed death certificate can be a time consuming and costly process. It may also require documents of proof that may be difficult to find.

This form is secure and cannot be accessed by other people on the Internet. Schlossberg Chapel will only use your information for the express purpose contained in this form.

Name of Person For Whom Funeral is Being Arranged:

Telephone Number:

Address:

Town/City:

State:

Zip Code:

Date of Birth:

Place of Birth:

Marital Status:

Last Spouse's Name:

Spouse's Maiden Name:

Highest Grade Completed

Occupation:

Industry / Business

Social Security Number:

Father's Full Name:

Father's Place of Birth:(State or Country)

Mother's Full Name:

Maiden Name:

Mother's Place of Birth:(State or Country)

Person who will be in charge of funeral arrangements

Relationship:

Name:

Address:

Town/City:

State:

Zip Code:

Telephone Number:

E-mail Address:

Military Information

Branch of Service:

Description of Service
(Wars or conflicts fought in):

Veteran's Service Number:

Rank:

Location of Discharge Papers:

Family Members

Sons & Daughters:(and Hometowns)

Grandchildren and Great-Grandchildren:(First names only, unless married)

Sisters & brothers-including late:(Hometowns)

My Funeral Service Preferences

Place of Service:(Funeral Home, Synagogue/Temple, Graveside, or other)

Synagogue/Temple Name:

Type of Interment:

Cemetery Property Owned?

If Owned - Name of Cemetery:(City, & State)

Section:

Lot:

Row:

Space:

Memorial Contributions / Donations:

Any information or special instructions or wishes not previously listed: