Please fill out this secure preneed planning form and click the submit button below to send the information to us at the funeral home to be used in preplaning your funeral. 

 

Personal Information
Name (First Middle Last):    
Marital Status:    
Date of Birth:    
Place Of Birth:    
Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Place of Marriage: Date of Marriage:
Father's Name: Mother's Name:
Mother's Maiden Name:    
Informant:    
Address:    
Phone:    
Work/Education History
Education (0-12): College 1-5+:
Occupation:
Business: Company:
Military Record
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Participated in Wars
Funeral Service Request
Place Of Service:    
Funeral Home:
Address:
Phone:    
Place of Visitation:
Religious Denomination:
Place Of Worship:
Newspaper Information
 

Please list family members

  
Children:
Brothers/Sisters:
Number of Grandchildren:    
List any other significant relatives:
Special Instructions
Organizations: 1.
2.
3.
Jewelry/Glasses
Do you have an existing Pre-Arrangement with another funeral home?
Person in Charge of Arrangements:
Other Instructions
 
Memorials/Donations To Charity
 

Nolan & Taylor - Howe Funeral Home
Phone: 1-800-261-8338    ||    Email: info@nthfh.com    ||    Phone: 631-754-2400

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