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Terpening & Son Mortuary
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Terpening & Son Mortuary.
*Require fields

Person Completing this Form*:
Relationship*:
Email*:
 
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
Address:
(no P.O. Box)
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran: Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
 
Family Member Information

Family Member #1

 
Funeral Arrangement Details
Person in charge of arrangements:
 
Place of service or gathering:
If Other, please specify:

 

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:
 

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?

 

Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

  security code
Enter Security Code:

 
Adrian Martinez
Born: 12/30/1925
Died: 5/16/2017
George Fitzpatrick IV
Born: 7/14/1946
Died: 5/13/2017
Margaret Montgomery
Born: 10/28/1926
Died: 5/13/2017
Jake Williams
Born: 4/21/1952
Died: 5/12/2017
Patti Meinke
Born: 1/22/1938
Died: 5/3/2017
Proto Leyva, Jr.
Born: 1/27/1938
Died: 4/30/2017
Bryce Bowerman
Born: 10/14/1996
Died: 4/29/2017
Winna Gage
Born: 2/26/1951
Died: 4/27/2017
Michael Jones
Born: 2/9/1954
Died: 4/25/2017

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Terpening & Son Mortuary | 611 W. Grand Ave. | Artesia, NM 88210 | 575-746-2231
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