Helpful Forms

Biographical Information For:

Contact Name and Telephone:

First

Middle

Last

Maiden

Address:

Date of Birth:

Place of Birth (City and State:)

Race:

Sex:

Highest Education(Name of School):

Mother’s Full Name and Maiden Name:

Mother’s Place of Birth:

Marital Status:

Spouse(Maiden Name):

Living Y or N

Date of Spouse's Death:

Date and Place of Marriage:

Usual Occupation:

Employer:

Social Security Number:

Veteran: Yes or No

Branch:

Rank:

Dates of Service:

Till

Service Number:

Length of Time Living in Area:

Moved From:

Church Preference:

Clubs or Organizations:

Survivors

Spouse:

Parents:

Children () Sons () Daughters

() Brothers () Sisters

() Grand Children

() Great Grandchildren

() Great Great Grandchildren

Other Survivors:

Preceded in death by:

Songs to be played:

Musicians:

Place of Services (Church, Chapel or Graveside):

City:

State:

Minister:

Cemetery(Name):

Cemetery(Name) :

Minister:

Cemetery(Name) :

City:

State:

Grave Lot:

Section:

Block:

Lot Owners:

Additional Cemetery Information:

Type of Casket Selected:

Type of Outer Burial Container Selected:

Additional Information:

Childhood / Teen Years:

Raised in

Activities

Education:

Elem School

High School

College

Major / Degrees

College

Major / Degrees

College

Major / Degrees

Military status

served

Honors

Marriage(s):

Date

Location

Years married

How they met

Honeymoon

Date

Location

Years married

Honeymoon

Occupation(s):

First Job

Location

Job

Location

Job

Location

Job

Location

Job

Location

Awards/honors

Social/Civic/Ethnic orgs /leadership Positions:

What are your memories of family activities/traditions/trips/holidays?

When you think of

what do you see him/her doing?

Hobbies/Interests

Sayings/Trademarks/Values/enjoyed talking about:

Pets

Travel/entertainment/vacations

Music/Concerts/Bands

TV programs/films

Personality traits: (3 or more adjectives or characteristics):

Struggles/challenges

What made your relationship special

Other people to contact:

Service Planning

Musical selections (live/CD):

Selected readings/poems/prayer/Memorial card verse to include in service:

Is there a video tribute?

Played during service or before?

Military Honors?

During Service or at Graveside?

Fraternal Order/civic group presentation?

Time needed

Other family rituals at closing/items to be placed in/on casket?

Other Participants/roles

Interment/Inurnment at (cemetery location/Date/time)

Verses/music at graveside/flowers/tree planting

Dear Friends and Family, Remembering others as they really were to us and not so much as we imagined them to be is helpful. It is my hope in planning my funeral that it will be helpful for my family and friends. My answers to the following questions will enable you to organize a personalized funeral that will help you remember me as I was and in so doing will assist you in your grieving. Remember the struggles, emphasis the love we shared and celebrate our good times together and I will be with you always.

I would like to leave the following spiritual message and have the following personal religious convictions expressed at my funeral

Some of the accomplishments I feel good about are:

Some of my fondest memories are:

The people that have had the greatest effect on my life, are:

My Favorite Scripture is:

My favorite quote is:

My Hobbies are or have been:

The people I would like to say goodbye to are:

If I could live life over again I would:

I would spend less time:

I would spend more time:

If I could do anything before I die, I would:

The things I always wanted to do yet did not are:

The behaviors and attitudes that held me back and kept me from getting what I wanted are:

The behaviors and attitudes I admired in others and that I would like to be remembered by are:

The things that gave me enjoyment in life were:

The causes and beliefs I was passionate about are:

The most fun I ever had was:

I was the most proud of:

I would describe myself as:

I would like to say the following to the following People:

1. At my funeral please do the following:

At my funeral please do the following:

My funeral should be held at:

Display the following items at my funeral:

My Body should be:

Buried

Cremated

Entombed

And laid to rest at

Based upon the above information my request for the funeral is:

A Note To My Loving Family I have taken the time to record my thoughts and wishes so my family can have an easier time at my passing. Death is inevitable, no one escapes its grip, however, we can plan for it and minimize the pain. It is my desire to reduce the stress, anxiety and expense for the ones I love the most, my family. I offer these thoughts as guidelines; it is my hope that you find some comfort in them. I love you all, so much! Don’t cry for me. I’ve lived a full life. I have put Myself in God’s care. If I can, I’ll help you. I’ll be right there beside you.

Signature:

Date:

Listen With Your Heart Memories are a treasure time cannot take away… So may you be surrounded by happy ones today… May all the love and tenderness of golden years well spent Come back today to fill your heart with beauty and content… And may you walk down Memory Lane and meet the one you love For while you cannot see him, he’ll be watching form above… And if you trust your dreaming your faith will make it true… And if you listen with your heart he’ll come and talk with you… So for his sake be happy and show him that his love Has proven strong and big enough to reach down from above… And you will never walk alone when Memory’s Door swings wide… For you’ll find that your beloved is always at you side.

Get in Touch

Chapman-Black Funeral Home

108 West Delaware Street

Cleveland, OK 74020

Phone: (918) 358-2511

Toll Free: (800) 252-4507

Fax: (918) 358-1400

Poteet Funeral Home

600 Illinois Street

Pawnee, OK 74058

Phone: (918) 762-2557

Powell Funeral Home

223 North Wood Avenue

Hominy, OK 74035

Phone: (918) 885-2128