Preplanning Worksheet

Preplanning your own, or a loved one's, funeral prior to death allows you to express your own wishes. Preplanning relieves your family of making stressful decisions at a difficult time. Preplanning does not require prepayment, however, a prepayment option is available.

The Burns Funeral Home is here to assist you with your funeral preplanning. You can contact us to arrange a time to meet, or you can start the process by completing and submitting this form. If you wish for the Burns Funeral Home to contact you to arrange a meeting to discuss all of your options, please choose the appropriate option at the bottom of the form. If you wish, we can also file the information until you are ready to meet in person.

 

Please Note: This form should not be used to report a death of a loved one. In those cases, please immediately call the funeral home to make the proper arrangements at 978-663-3968 (Billerica) or 617-876-8336 (Cambridge).

 

Personal Information

Name (maiden) Gender Race

Date of Birth Place of Birth

Street Address

City State Zip County

Home Phone Email

Father Father's Birthplace

Mother (maiden) Mother's Birthplace

Marital Status Date of Marriage Spouse's Name (maiden)

Education & Occupation

Years of Education Schools Attended Include

Occupation Business/Industry

Employer Years with Employer

Military/Veteran Information

Branch of Service Serial Number

Wartime Service List Wars/Conflicts

Enlistment Date Discharge Date Discharge Location

Highest Rank Achieved Organization/Outfit

Name of Person Completing Form - Note: Name and email address are required fields

Name Relation to Person Named Above

Street Address

City State Zip County

Home Phone Email

Funeral Service Information

Funeral Home Visitation yes - Hours Desired (if applicable)

Church Service yes

Funeral Home Service yes

Cremation Requested yes

Religious Affiliation

Church Denomination Location

Final Disposition

Cemetery Name Cemetery Location

Cemetery Phone Number

Plot Location (Section/Location) - if already purchased

Additional Information

Please note - Server will not accept web addresses

Other Affiliations (unions, fraternal organizations, community involvement, etc.)

Relation Information (family members, their spouses, towns, etc.)

Additional Information (activities, interests, memorial donations, etc.)

How Funeral Home Should Handle Information

Contact me to schedule an appointment yes

Do not contact me. Hold information until I contact you yes

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