To help you prepare...

This form has been designed to help you print the important information that will be needed at the time funeral arrangements are made.  This information will assist us in obtaining death certificates, preparing obituaries and other vital tasks related to the funeral service.  Please take a few moments to complete this form as thoroughly as possible.  After completing the form, please print it off and mail it to us for our records or keep it in a safe place.  If you decide to keep the form, please make certain someone knows where the information can be found. 

Arrangements being made for (full name) 

Address      City

State      Zip Code

Phone number      Hebrew name

Social Security Number (Please call with this information)     Place of birth

Date of birth      Father's name

Mother's name (include maiden name)

Marital status (married, divorced, etc)      Name of spouse

Other places where you have lived and important biographical information

Years of Education (K - 16 or higher)     

Schools attended (if you want them in the obituary) 

Military Service:  Branch      Rate/Rank      Enlisted

      Discharge date / place      Service #      War

Occupation       Industry

Religious affiliation

Clubs and Organizations 

Physician      Address 

Clergy      Congregation

Attorney      Address

Executor of Estate      Address

Location of Will      Location of safe deposit box

Location of funeral service (funeral home, congregation, graveside)

Organizations to participate in service (Masons, etc)

Floral preferences

Clothing and jewelry (if applicable)

Memorial donations to

Disposition preference (burial, cremation, entombment, etc)

Cemetery location

Other preferences 


Once you have filled in the form, you can print it using your browser's print feature and mail it to us.

Herman Meyer & Son, PO Box 4052, Louisville, Kentucky 40204 | 502.458.9569 |

Copyright 1997 by Herman Meyer & Son, Inc, All rights reserved.