Pre-Plan Form - Hughes Funeral Home

Information for the person the plan is for
Full Name:*
First Middle Last
(As It Appears On Social Security Card)
Maiden Name
Social Security Number
Phone:*
Email:
Address:*
Street Address City State ZIP Code
Inside City Limits:
- Yes
- No
Sex:*
Race:*
Marital Status:*
- Married
- Single
- Widowed
Name of Spouse:
First Middle Last
Spouse Maiden Name:
Next of Kin:
First Middle Last
Relation:
Father's Name:
First Middle Last
Mothers's Name:
First Middle Last
Education/Work
Highest Level of Education:
Occupation:
(Prior to Retirement)
Industry:
Military Service
Military Service
- Yes
- No
Branch of Service:
Funeral Home will need to have a copy of the discharge or separation papers form DD-214.
Burial or Cremation?
- Burial
- Cremation