Dering's Funeral Home (304) 296-6236 • 156 Foundry Street Morgantown, WV
 Preplan Form
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If you're interested in preplanning your arrangements, you may file vital statistic and preferred funeral information with us on-line by filling in the following information:

Name

 

Mailing Address

 

City

 

ST

 

Zip

 

Marital Status

 

Soc. Security #

 

Birth Date

 

Birth Place

 

Phone

 

E-Mail

 

Spouse's Name

 

Spouses Maiden Name

 

Place of Marriage

 

Date of Marriage

 

Father's Name

 

Mother's Name

 

 

 

Mother's Maiden Name

 

Work & Education History

Education

 

Occupation

 

Business

 

Company

 

Branch of Service

 

Serial Number

 

Date Enlisted

 

Rank At Discharge

 

Date Discharged

 

Discharge on File At

 

Copy of Discharge Papers

 (Click if Yes)

   
       

Name of Wars

 

Person in Charge

 

Address

 

Phone

 

Insurance Information

 

Funeral Service Request

Place of Service

 

Funeral Home

 

Address

 

Phone

 

Place of Visitation

 

Religious Denomination

 

Place of Worship

 

Lodge/Union

 

Person in charge of final arrangements

 

Special Instructions

Flower Preferences

 

Music Preferences

 

Casket Bearers (6)

1. 
2. 
3. 
4. 
5. 
6. 

Jewelry

 

Glasses

 

Clothing

 

Other

 

Disposition Request

I prefer

 

Cemetery

 

Address

 

Phone

 

Section

 

I have made last will and testament

 Yes No

Location

 

Other Instructions


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