Roseberry's Funeral Home & Crematory

Funeral Planner
Please fill in the information below for the person the arrangements are for
First Name		Date of Birth(//****)
Middle Name		Birth City
Last Name		Birth State
Mailing Address (PO Box )		Name of Spouse (if wife use maiden)
Street Address		Marriage Date(//****)
City, Village, or Township		Marriage Place (City, State)
Type of City		Marriage Status
County		Occupation
State		Industry
Zip		Father's Name
Highest Grade Completed		Mother's Name (use maiden)
Phone Number
*Cemetery Information*
Cemetery		Section of Grave
City		Lot Number
County		Grave
State		Monument Status
*Military Service Information*
Veteran (yes or no)		Rank
Branch		Serial Number
War		Claim Number
Date of Entry(//****)		Receiving Benefits from VA?
Date of Separation(//****)		VA Marker for Cemetery
		VA Marker Emblem
*Person Who Will Be "In Charge" of the Funeral Arrangements* please note: Wisconsin recently passed a law making it possible for people to name the person they wished to carry out their wishes regarding funeral arrangments. Click here to open form in a new window.
Informant's First Name		City
Informant's Middle Name		State
Informant's Last Name		Zip
Relationship		Phone
Informant's Mailing Address		Email
*Service Information*
Type of Service		Place of Visitation
Disposition		Fraternal Service
Place of Service		Minister
Service City		Organist
Type of Visitation		Luncheon Place
*Surviving Family Members* Please limit use of special characters...comma's are fine, anything else will not be accepted

*List Family members who have preceded in death* Please limit use of special characters...comma's are fine, anything else will not be accepted

*Hobbies and Clubs* Please limit use of special characters...comma's are fine, anything else will not be accepted

*Preneed Notes* List anything we should know... music, readings, which newspapers and radio stations to run obituary notice in...etc.... Please limit use of special characters...comma's are fine, anything else will not be accepted

*Person Submitting this form*
Name
Phone
Email
This Plan is for: