Pre-Plan with Kennedy-Amis-Kennard Funeral Service

Pre-Need Planning Form


Complete the form below to send Kennedy-Amis-Kennard Funeral Service your Pre-Planning needs.  A representative will review your needs and contact you soon.
Personal Information:  
   
I am planning for:
Your Name:
E-Mail Address:
   
Person You Are Pre-Need Planning For:  
   
Full Legal Name:
Date Of Birth: Example: 1/1/2010
Place Of Birth:
Street Address:
City:
State:
Zip Code:
Daytime Phone:
Evening Phone:
E-Mail Address:
Sex: Male    Female
SSN#
Race:
Hispanic Origin? Yes    No
If Yes, Specify:
   
Occupations & Employers:
Business Or Industry:
Last Position Held:
How Long?
Retired? Yes    No
If Retired, Year:
Last Residence:
Length Of Time:
High School Name:
Graduated? Yes    No
Education:
College(s) - Years Attended & Degrees Earned:  
 
Clubs Or Fraternal Organizations:  
 
Hobbies, Affiliations, Lodges, Memberships, Church Attended, etc.  
 
Comments/Questions Or Additional Information:  
 
Church Affiliation:
UAW Member Or Member Of Any Other Union? (Please Specity Local #)  
 
Marital Status:
Spouse's Full Legal Name  (If Wife, Include Maiden Name)  
 
Date Of Marriage: Example: 1/1/2010
Place Of Marriage:
If Spouse Is Deceased, Please Provide Date Of Death:  
  Example: 1/1/2010
Father's Legal Name:
Father's Birthplace:
Mother's Legal Name:
Mother's Birthplace:
Mother's Maiden Name:
   
Veteran's Information:  
   
Branch Of Service:
War Service & Awards:  
Enlistment Date:
Enlistment Place:
Discharge Date:
Discharge Rank:
Service Number:
   
Person Responsible For Funeral Arrangements:  
   
Name:
Address:
Phone:
E-Mail:
   
Family Members:  
   
Please list surviving family members below, name and relationship (including spouse), children, parents, grandparents, brothers, sisters, grandchildren, etc., and City/State where they are currently living.  
 
   
Pre-Deceased By The Following Family Members:  
 
Funeral Service Information:  
Please Select One Of The Following As Your Preference:  
   
Traditional Funeral Service    Traditional Cremation Service  
Graveside Burial Service        Memorial Cremation Service  
Immediate Burial                  Graveside Cremation Service  
Direct Cremation  
   
Clergy:
Cemetery:
City & State:
Holder Of Deed:
Location: (Section, Block, Grave Number, etc.)  
 
Marker Installed? Yes    No
Name Of Cemetery Or Property Owner:  
 
Special Instructions:  
 
   
Services To Be Held At:  
Broken Arrow Location    Catoosa Location  
Church/Church Name:  
Other/Specify:           
Graveside  
Rosary  
Prayer Service  
If A Veteran, Flag Is To Be: Draped    Folded  
Flag Should Be Given To:
   
Please List Any Musicians And Music Selections:  
 
   
Pallbearers: (Name/Phone Number If You Would like For Us To Notify)  
 
   
Honorary Pallbearers:  
 
   
Casket & Burial Preferences:
Material:
Exterior Color:
Interior:
Burial Vault:
   
Special Wishes: (Clothing, Jewelry, etc.)  
 
   
Bible Passages, Poetry, Quotations, Verses, etc. And Who Should Read Them:  
 
   
Memorial Contributions To:  
 
   
Participating Organizations: (List All That Apply, Including Masonic Lodge And It's Number, Veterans/VFW Lodge And It's Number, Knights Of Columbus, Lions Club And Any Other Fraternal/Military Rites.  
 
   
Newspapers:  
KAKFS Will Notify The Local Newspaper Within Your Community.  
   
What Other Newspspers Should Be Notified?  
 
   
Photo In the Obituary?   Yes    No
   
Local Emergency Contacts To Be Notified At Time Of Death.  Please Include Full Name, Address, Phone, E-Mail Address And Relationship:  
 
   
Important Legal Information For Family Use: (Not Required)
   
Will Location:
Attorney Name & Contact Information: (Please Provide Full Name, Address, Phone & E-Mail)  
 
   
Executor Of Estate: (Please Provide Full Name, Address, Phone & E-Mail)  
 
   
Safety Deposit Box Location: (Please Provide Name Of Institution, Address & Phone)  
 
   
Additional Information: (Please Include Insurance Policies, etc.)  
   
Living Will: Yes    No
Living Trust:
Receiving VA Benefits? Yes    No  (Funeral Home will notify at time of death)
If Yes, Are You Disabled? Yes    No
Receiving Pension? Yes    No  (Funeral Home will notify at time of death)
Receiving Social Security Benefits? Yes    No  (Funeral Home will notify at time of death)
   
Personal Reflection:  
   
The People Who Have Had The Greatest And Most Profound Impact On My Life Have Been:  
 
   
Some Of The Accomplishments That I am Most Proud Of Are:  
 
   
My Fondest Memories Include:  
 
   
If I Could Live Life Over Again, I Would Spend Less Time:  
 
   
Is There A Special Story About You Or Your Loved One's Heritage That You Would Like To Share?  
 
   
Do You Or Your Loved One Have A Favorite Scripture, Song, Saying Or Poem?  
 
   
What Lasting Memory Will Those Who Knew You Or Your Loved One Remember?  
 
   
How Would You Or Your Loved One Want To Say Goodbye And What Messages Would You/They Like To Leave?  
 
   
E-Mail Notifications At Time Of Death To Be Sent To: (Please Separate Each E-Mail Address By A Comma)  
 
   
Address Where Pre-Arrangement Documents Can Be Delivered: (Address, Phone & Contact)  
   
 
   
Please Call Me  
Tell Me How To Pre-Pay Expenses  
Please Keep My Information On File  
   
How Did You Hear About KAKFS?
Which Facility Do You Plan To Use?
   
If you would like to speak with someone at any time, or have questions in regards to the pre-arrangement process or this document, please feel free to contact KAKFS anytime at 918-251-5331.  
   
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