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Grace Memorial Chapel
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Grace Memorial Chapel.
*Require fields

Person Completing this Form*:
Relationship*:
Email*:
 
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
Address:
(no P.O. Box)
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran: Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
 
Family Member Information

Family Member #1

 
Funeral Arrangement Details
Person in charge of arrangements:
 
Place of service or gathering:
If Other, please specify:

 

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:
 

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?

 

Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

  security code
Enter Security Code:

 
Jerry Winkelman
Born: 7/13/1966
Died: 1/15/2018
LaJune Justice
Born: 8/3/1924
Died: 1/11/2018
Richard Becker
Born: 6/3/1945
Died: 1/9/2018
Patricia Hasenfratz
Born: 4/9/1942
Died: 1/7/2018
Jerelean Hurd
Born: 10/23/1927
Died: 1/5/2018
Gale Prather
Born: 2/24/1926
Died: 1/5/2018
Gloria Gordon
Born: 8/13/1951
Died: 12/30/2017
Sylvia Hare
Born: 11/26/1936
Died: 12/30/2017
Lemuel Rhodd Jr
Born: 11/22/1945
Died: 12/28/2017

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Grace Memorial Chapel | 2016 N. 14th St. | Ponca City, OK 74601 | 580-762-2464
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