FREMONT CHAPEL OF THE ROSES & FREMONT MEMORIAL CHAPEL

Pre-Planning Form

Since 1958, the Rose Family has been dedicated to providing families with quality service when they need it most. Fremont Chapel of the Roses & Fremont Memorial Chapel specialize in advanced planning funerals and can assist you with all of the aspects of advanced planning a funeral, memorial, or cremation service. Our facilities and staff are devoted to providing excellent service within a comfortable atmosphere.

Thoughtful preparation can ease the process for both those making the plans and those left behind, bringing peace of mind to well-prepared families.

It's an emotional time when we have a loss and advanced planning facilitates an easier time planning arrangements. Advanced planning is not just thoughtful but practical as well, since making the decisions unrushed and carefully usually leads to better decisions. Organizing your documents ahead of time to ensure your survivors have the information they need to avoid overlooking insurance or benefits can assure that nothing is left to chance and with advanced planning you can choose to invest in a payment plan, protecting against inflation and freeing funds for your loved ones when they will most need them.

Advanced planning allows you to choose a reasonable budget and permits you the option to set aside the funds over a period of time. Funds set aside against future cost are held in a state-approved trust account or top-rated insurance company until required. There is no charge for making prearrangements and many families simply prefer to record this vital information for future use.

I am planning for:
Informant Contact Info
Name:
Address:
Phone Number:
Email Address:
Personal Information
Name (First, Middle, Last):
AKA (First, Middle, Last):
Date of Birth:
Sex:
Birth State/Foreign Country:
Social Security Number:
Ever in U.S. Armed Forces:
Branch of Service:
Marital Status:
Education (Highest Level/Degree):
Hispanic/Latino(a)/Spanish?:
Race:
Usual Occupation (Type of Work for Most of Life):
Business/Industry:
Years in Occupation:
Address of Residence:
City:
State/Foreign Country:
Zip Code:
County:
In County Since (19-- or 20--):
Name of Surviving Spouse (First, Middle, Last-Maiden Name):
Name of Father (First, Middle, Last):
Father's Birth State/Foreign Country:
Name of Mother (First, Middle, Last-Maiden Name):
Mother's Birth State/Foreign Country:
Hobbies:
Organizations:
I would like to email you a copy to have on record of the:
Medical Information
Primary Physician:
Physician's Phone Number:
Kaiser Medical Record Number:
Hospice Name:
Family Information
Please list their relationship, name, spouse's name, and city & state in which they live. Ex: (Son: Joe Smith & his wife Joan of
Survivors:
Please list their relationship, name, and year of death. Ex: (Husband: John Brown in 1999)
Preceded in Death by:
Service Information
Religious Preference:
I prefer:
Viewing:
Church:
Cremains to:
Cemetery:

For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.

Nicolee "Nikki" Bucol