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Ms Velma C Johnson
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Pre Need Application

 

Heritage Funeral Services - Preneed (Advanced Planning)
According to all the surveys, the most important benefit of making funeral arrangements in advance is PEACE OF MIND.
In addition, pre-planning your funeral.…
Removes the decision-making burden from the shoulders of loved ones at the time of need.
Assures that your wishes and preferences for funeral services are known.
Helps settle any differences that may arise within your family about the type and costs of the funeral service.
Allows you to meet with the funeral director and ask questions about service options.
Having the opportunity to set aside funds in advance to protect against inflation.
To start pre-planning now, fill out our on-line form below:
     Information about person completing the form:
Your Full Name:
Contact Phone 1:
Contact Phone 2:
Email Address:
 
I am planning for my:
     Personal Information about person planning for
     
(Be sure to use their Full Legal Name)
Preneed Full Name:
Sex:
Marital Status:
Date of Birth:
Place of Birth:
   
     Personal Address information
     
(Be sure to complete as much as possible)
Street Address 1:
Address line 2:
City:
State:
Zip Code:
   
     Personal Family information    
Spouse's Full Name:
Spouse's Maiden Name:
Mother's Name:
Mother's Maiden Name:
Father's Name:
   
     Funeral Preferences     
I Prefer The Funeral Service To Be:
Place of Service:
Name Of Cemetery:
City:
State:
Grave or Niche Location:
Religious Denomination:
Church Affiliation:
Name:
Viewing For Family:
Viewing For Friends:
I Prefer:
Option:
   
     Funeral Preferences *  
     Musical Selections To Be Played
Track 1:
Track 2:
Track 3:
Track 4:
     Musical Selections To Be Sung:
Song 1:
Song 2:
Song 3:
Song 4:
will supply cd or tape for service
Favorite Bible Passages:
Favorite Literature Or Poems:
Favorite Flower(s):
Favorite Flower Color:
   
     Final Disposition
Preference For Final Disposition Is:
   
     Obituary Information
Survivor Name
Relationship
   
     Person(s) To Finalize Arrangements At Time Of Death
Name:
Relationship:
Contact Phone #(s):
Address:
Second Contact:
Relationship:
Contact Phone #(s):
Address:
   
     Special Instructions
Other Information:
People To Contact:
Etc:
Please Call Me
Tell Me How To Pre-Pay Expenses
Keep Information On File
 
 
  Heritage Funeral Services - “A Name Honoring Timeless Traditions”
  1010 East Brambleton Ave Norfolk, Virginia, 23504
  Phone:(757) 622-1016  Fax:(757) 622-2262

 
© 2009  Heritage Funeral Services Norkfolk Virginia