Grimes Funeral Chapels Prearrangement Form

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This secure form was designed to assist you in submitting important information to us that is needed when death occurs.

	Full Legal Name:
	Preferred Name for Obituary:
	Home Address:
	City, State, Zip:
	Telephone:	(ex: xxx-xxx-xxxx)
	Inside City Limits:
	County:
	Length of Residence:
	Prior Residence:
	Sex:
	Race:
	Spanish Origin:
	Date of Birth:
	Place of Birth:
	Maiden Name of Deceased:
	Education/Years:
	Father's Name:
	Mother's Maiden Name:
	Marital Status:
	Occupation:
	Kind of Business:
	Military Information
	Organization:
	Rank:
	Date Entered:
	Place:
	Date Discharged:
	Place:
	Serial No.:
	Claim No.:
	Church Affiliation:
	Organizations:

	Services
	Place:
	Minister:
	Interment:
	City:
	County:
	Section:
	Block:
	Lot:
	Space:
	Family Visitation:
	Memorials To:
	Newspapers to Notify:
	Suggested Readings, Poetry, etc:
	Floral Preference:
	Clothing and Jewelry Preference:
	Instructions for Hairdresser:
	Pallbearers:
	Honorary Pallbearers:
	Organizations to Participate in Service:

	Survivors Information
	Spouse:
	Parents:
	Grandparents:
	Children:
	Brothers/Sisters:
	Grandchildren:
	Additional Information:

	Information Provided by
	Your Name:
	E-mail Address:
	Today's Date:
		Send information about prearrangements
		Contact me to set up an appointment
		Please keep my information on file

Before sending, please print this page for your file.

728 Jefferson, Kerrville, Texas 78028 * Tel: 830.257.4544

1214 Mulberry, Bandera, Texas 78003 * Tel: 830.796.3922

www.grimesfuneralchapels.com