Last Name:
Address:
First Name:
Information about person completing this form:
I am planning for:
Grunnagle-Ament-Nelson
Family Funeral Home
& Crematory
Middle Name:
E-Mail:
City:
County:
Zip Code:
Phone:
Vital Information about the person you are planning for:
Last Name:
First Name:
Middle Name:
Sex:
Marital Status:
Social Security#:
Date of Birth:
Place Of Birth:
Spouse's Full Name:
Spouse's Maiden Name:
Place of Marriage:
Date of Marriage:
Father's Full Name:
Mothers Full Name:
Mother's Maiden Name:
Education and Work:
Education:
Usual Occupation:
Kind of Business:
Company (Optional):
Military Records
Branch of Service:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:
Copy of Discharge Papers:
Name Of Wars:
Funeral Service Information:
Place Of Service:
Name of Funeral Home:
Address:
Phone:
Place of Visitation:
I Prefer the Service to Be:
Viewing For Family:
Viewing For Friends:
Religious Denomination:
Place Of Worship:
Lodge/Union:
Person(s) To Finalize:
Arrangements
Check here and skip this section if the information is the same as person filling out this form.
Full Name:
Street Address:
City:
County:
State:
Zip Code:
Phone:
Special Instructions
Flower Preference:
Music:
Paul Bearers (6):
Jewelry:
Glasses:
Clothing:
Other:
Disposition Options:
I/we Prefer:
Cemetery:
Address:
Phone:
Additional Points of Interest
A last will and testament:
Other Information & Special Instructions. Please list any
other instruction or information you would like us to have.
Memorials & Charities
Please list any Memorials or Donations to Charity that you would like others to know.
Options:
Please select one of the options below:
Pre-Planning
The most favored Funeral Home in San Benito County
(most of life)
At time of death
State:
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