Shaw Funeral Home, Inc. :: Funeral Wishes Form

Personal Information and Funeral Wishes

Complete the following to the best of your ability. Your name, phone and email address are required so we can contact you if we have questions about the information submitted.

*Required Fields

This information is *

An inquiry for pre-planning services. Information about my deceased loved one. An update to my previous submission.

Personal Information

Name *

Mailing Address *

City, Town or Township *

Date of Birth
(i.e., 01-01-1950) *

Place of Birth *

State *

Zip

Father's Name *

Mother's Name
(with maiden name) *

Marital Status

Spouse

Date of Marriage

Children (Town/City)

# of Grandchildren

# of Great Grandchildren

Brothers (Town/City)

Sisters (Town/City)

Education and Work

High School or College

Year Graduated

Educational Notes

Occupation

# of Years Employed

Year Retired

Work Notes

Additional Information

Clubs and Organizations

Church Affiliation

Veteran Information

Funeral Wishes

Funeral Information

Cemetery

Clergyman

Submitted By

Your Name *

Email *

Phone *

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