A

Personal
Pre-Planning
Funeral Guide

265 West 8th Ave. Springfield, CO 81073

OFFICE: 719-523-4543 Fax: 719-523-1833
TOLL FREE: 1-888-384-4543
www.maltbiefuneralservices.com

Often times, when families come to make arrangements for

a loved one, we hear them say,
I wish I knew what she would have preferred.
He never said . . . I wish I knew.
With this planning guide, we trust that any confusion,
uncertainty or unnecessary expense will be avoided.
Our goal is to ensure that all of your personal choices
are carried out exactly as you desire.
Your planning guide should be kept in a safe place that is
readily accessible to your family. It should not be kept in a safedeposit box. If you would like, you are welcome to keep a copy,
on file, in our office.
We are here to serve your needs professionally and
sensitively.
Should you have any questions regarding these
arrangements, please feel free to stop by our office or call at any
time.

PERSONAL RECORD
Before burial or cremation can take place, it is necessary to have the following vital information
obtained for the death certificate.
FULL LEGAL NAME ________________________________________ Male Female
First
Middle
Last
SOCIAL SECURITY NUMBER _______________________________________________________
BIRTH DATE _________________________PLACE of BIRTH: _____________________________
WERE YOU EVER IN THE U.S. ARMED FORCES Yes No
USUAL OCCUPATION/Title (Kind of work done during most of working life Retired is not
accepted)
______________________________________________________________________________
KIND OF BUSINESS OR INDUSTRY (Not the company name)
______________________________________________________________________________
MARITAL STATUS Married Never Married Widowed Divorced
SPOUSE (If wife, give maiden name)
______________________________________________________________________________
First
Middle
Last (Maiden)
RESIDENDIAL ADDRESS
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
COUNTY OF RESIDENCE___________________________________________________________
RESIDENCE INSIDE CITY LIMITS Yes No
HISPANIC ORIGIN OR DESCENT Yes No
If yes, specify: Cuban, Mexican, Puerto Rican, etc.______________________________________
RACE YOU CONSIDER YOURSELF TO BE:
Caucasian, Asian, American Indian, Black/African-American, Hispanic, Other (name)__________
EDUCATION in years (Specify highest grade completed or degree earned) __________________
FATHERS NAME ________________________________________________________________
First
Middle
Last
MOTHERS NAME _______________________________________________________________
First
Middle
Maiden Name
Who would you like to carry out the following wishes and desires? Name and contact
info of Child(ren), Spouse, Friend etc.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

OBITUARY INFORMATION
Consider including a basic timeline with dates and important events. This
will help in writing a more detailed obituary. Additional room is available on
the last page of this booklet
The following are hobbies and/or personal interests I would like included in
an obituary
___________________________________________________________________
___________________________________________________________________
Clubs, lodges, membership in various organizations, church affiliation and
activities
___________________________________________________________________
___________________________________________________________________
Military service
___________________________________________________________________
___________________________________________________________________
Special Recognition and/or Achievements
___________________________________________________________________
___________________________________________________________________
Other information I would like to have included
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Survived by
Name
Relationship
City & State
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Pre-deceased by
Name
Relationship
Year of Death
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

BURIAL/CREMATION
My preference regarding disposal of my body is
Ground burial in __________________________ Cemetery
Mausoleum in ____________________________Mausoleum
Cremation
I prefer that my cremated remains (ashes) be interred into a
Niche Burial plot
Scattered
I HAVE HAVE NOT purchased the plot/crypt/niche necessary for
interment
CEREMONY PREFERENCES
I prefer a funeral ceremony before burial or cremation
I prefer a funeral ceremony after burial or cremation
Funeral Home Chapel
Church (specify) ____________________________________________
Other (specify)_____________________________________________
Graveside
I want a Military Service using Local VFW Out of county VFW
In order to receive full military honors including a military marker and flag,
you will need to provide a copy of your DD214 (military release form).
Please consider placing it with this booklet.
I prefer
Open casket-Viewing at service
Viewing only at the funeral home prior to ceremony
Family and friends only
Immediate family only
No viewing/no open casket
I do not have a preference

MUSIC
Person/s I would like to have sing/play
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Songs
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
I would like the following Bible verses read
(I prefer _____________________________ version of the Bible)
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
SUGGESTED MEMORIAL DONATIONS
I want my family and friends to know of my appreciation of the following
organizations, ministries, and/or charities
Name & Address
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Some things I would like to have shared at the ceremony would be

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
PERSONAL PREFERENCES
Glasses to be worn Yes No Glasses to remain with me: Yes
No
Donate to Local Lions Club Return to family
Jewelry to be worn Yes
No_____________________________________
Jewelry to remain with me Yes No Return to family
I suggest the following to be Casket/Pall bearers
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
My preference for clergy/officiate is
___________________________________________________________________
___________________________________________________________________
MARKER/HEADSTONE
I would like a headstone with the following inscription/guideline
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

FINANCIAL INFORMATION
Life Insurance Policy
Insurance Company __________________________ Policy# __________
Agent ______________________________ Phone# _________________
Approximate face value $_____________ Beneficiary(s)_______________
Pre-Need Funeral Insurance
Insurance Company ___________________________Policy# __________
Agent ______________________________ Phone# _________________
Approximate face value $_____________ Beneficiary(s)_______________
Labor/Other Benefits
Labor Union__________________________________Local# __________
Burial Account at Banking Institution
Banking Institution_____________________________________________
Approximate value $ ___________________________________________
COMMENTS
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

SPECIAL NOTES AND WISHES

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