NOTE:
   This document is presented as a guide to the information requested by your funeral director when arranging an at need or prearranged funeral. This form may be filed electronically with the Harman - Wright Mortuary in Beatrice, Nebraska where it will be kept on file and can be provided to your family with proof of designation (ie. family, next of kin or executor). Not all the fields must be filled out, although the more information provided to us, the less information we must obtain from you later.  There is no charge for this service. This form should be printed and kept with your other important papers.
I am planning for 
 
Personal Information
Name:
Email Address: 
Address: 
City:  Province/State: 
Country:  Postal/Zip Code: 
SSN:  Phone Number: 
Place Of Birth:  Date of Birth: 
Sex:  Male: Female: Citizenship: 
Marital Status:  Spouse: (Maiden Name) 
Place of Marriage:  Date of Marriage:
Father's Name:  Father's Birthplace: 
Mother's Maiden Name:  Mother's Birthplace: 

Survivors:

(Please list the names of survivors, state their relationship to you,
their spouses names and the city in which they live as you wish to 
have them listed in the newspaper.)

(The following is a guide to assist you.) 
SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters,
Grandchildren, (Great), Grandparents, Others

(e.g.. Daughter: Erica Schmidt and her husband Bill of Beatrice)

Predeceased By:


Work History
Occupation:  Business: 
Industry:  Company: 
Number of years:  Year Retired:  N/A 
Military Service
Service Branch:  Serial Number: 
Date Enlisted:  Rank at Discharge: 
Date Discharged:  Discharge on File At: 
Combat Action: 
Funeral Preferences
I prefer my Funeral Service to be  Public Private
Visitation:  Yes: No:
Place of Service:  Other: 
Conclude Service at:  Other: 
Religious denomination: 
Place of Worship: 
Type of Clergy:  Other: 
I prefer  CremationBurialEntombment
Type of Clothing:  My OwnNew
Preferred Casket Type: 
Vehicle for Family 
Memorialization Instructions
Musical Selections to be Played 
Will Supply CD/Tape
Musical Selections to be Sung 
Favorite Bible Passages 
Favorite Literature or Poems 
Favorite Flowers 
Favorite Flower Color 
Donations: 
(e.g.. Cancer Society, Arthritis, Heart and Stroke etc.) 
Final Disposition
Preference for final disposition is:  Ground Interment with 
Mausoleum entombment 
Cremation with 
Cemetery Name: 
Cemetery Address: 
A is owned at above location. 
Finalizing Arrangements
Do you have a will? Yes: No:
Lawyer's Name: 
Executor's Name: 
Executor's Address: 
Executor's Phone Number: 
Executor's E-mail Address: 
Executor's Relationship to you: 
Next Of Kin: 
Address: 
Special Instructions
Important:  If there is anything you have seen at a funeral which you found objectionable or didn't like please describe it below.  Do you have other special instructions?
Please click either of the buttons below:

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