Caring family funeral service: Crowder-Hite-Crews Funeral Home and Crematory

					1504 N. Mecklenburg Avenue South Hill, VA 23970

Free bereavement information download.

To Help You Prepare

We at Crowder-Hite-Crews realize a family cannot always remember all the needed information when a loved one dies. Making funeral arrangements at the time of loss is extremely difficult for those left behind.

One of the most caring things you can do for your family is leave a detailed record of what you want for your funeral service. The more complete your information is, the less difficult it will be for them.

The following form has been designed to help you write down some of this information — for yourself or a loved one, and for your funeral home. If you choose to share this information with us, it will be kept in complete confidence and only used when needed — to prepare your obituary or other memorialization. It may be revised at any time and is always reviewed at the time of death.

After you fill in the information, use the buttons at the end of the form to:

Send it to us now online, or
To ensure your privacy, print a copy and mail it to us; and
Print a copy to keep with your important papers.

			* required

Your Name*:		E-mail Address*:
Daytime Phone:		Evening Phone:
I am planning for:		Best Time to Contact:


Full Legal Name:		Title (if any):
Maiden Name (if applicable):		Nickname:
Gender:	Male Female	Social Security Number:
Date of Birth:		Place of Birth:
Citizen of what country?
Street Address:		Zip Code:
Mailing Address (if different):		Zip Code (if different):
City:		Inside city limits?	Yes No
County:		State:


Marital Status:		Year widowed (if applicable):
Date Married:		Place Married:
Spouse's Name:		Spouse's Maiden Name:
Father's Name:		Father still alive?	Yes No
Mother's Name (include Maiden):		Mother still alive?	Yes No


Highest Grade Completed:		Years of College (1-4 or 5+):
Occupation:		Business or Industry:
Employer(s):		Years Retired:
Professional Organizations:		Fraternal Memberships:


Service Branch:		Military ID (Serial Number):
Date Enlisted:		Discharge Date:
Rank Held at Discharge:		Discharge on File At:
Wars:		Commendations Received:
VA File (Claim #):		Receiving VA Pension?	Yes No
Military Honors Desired?	Yes No	Present Flag To:
Flag Drape?	Yes No


Notice in Papers:	South Hill Richmond	Out of Town Papers:
Radio Station 1:		Radio Station 2:
How many children?		Grandchildren?
Great Grandchildren?		Great Great Grandchildren?

Survived By
Relationship	Name	City, State	E-mail Address













Preceded in Death By
Relationship	Name	Relationship	Name





Private Viewing for Family?	Yes No	Viewing for Friends?	Yes No
Preferred Disposition:		Organ or body donor?	Yes No
Cemetery or Crematory:		City/County and State:

Memorial Contributions:		Address / Specific Location:




For families choosing cremation, what disposition of the cremains do you prefer?		Please provide any other funeral preferences, special instructions or information:



Service Setting:	Public Private	Type of Service:
Place of Service:		Name of Place:
Religious Denomination:		Place of Worship:
Officiated By:		Person's Name:

Pallbearers
Phone Number	Name	City, State	E-mail Address









Musical Selections (if any):		Performed By / Will Supply Recording:






Favorite Bible Verses / Other Readings:		Reader(s) / Speaker(s):





Please list any other service preferences or information:


Name:		Relationship:
Address:		E-mail Address:
Daytime Phone:		Evening Phone:





Send information about pre-arrangement Contact me to set an appointment Call me to go over some questions I have Please keep my information on file Other (please describe in box on right)

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