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Pre-Planning Form

By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help Shurden-Jackson Funeral Home complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes. Relaying required information can be time consuming. Our desire is to help expedite the final arrangement conference at the funeral home and make the process a little more comfortable.

Please complete (as much as possible) the information on the form. You may also print out the form and bring it with you to the arrangement conference or fax.

If you have any questions, please contact Shurden-Jackson Funeral Home at 918-756-3300 (Okmulgee) or 918-652-4461 (Henryetta).

I am planning for:
Personal Information
Name:
Email Address:
Address:
City:
State/Province:
Country:
Zip Code:
Phone Number:
Place of Birth:
Date of Birth:
Sex:
Citizenship:
Marital Status:
Spouse (Maidenn Name):
Father's Name:
Mother's Maiden Name:
SSN:
Religous Preference:
Education
High School Name:
# of Years:
College Name:
# of Years::
Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)
Survivors:
Preceded in Death by::
Additional Information and Organ:
Work History
Occupation:
Business:
Industry:
Company:
Number of Years:
Years Retired:
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
Public:
Private:
Place of Service:
Other:
I prefer
Cremation:
Burial:
Entombment:

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