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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:

 
Susie Gomez
Born: 11/12/1929
Died: 4/24/2017
Joyce Collinsworth
Born: 5/11/1939
Died: 4/18/2017
Wilma Kendrick-Mauldin
Born: 8/7/1917
Died: 4/16/2017
Barbara Cardwell
Born: 8/19/1941
Died: 4/14/2017
Bernardo Howard
Born: 5/17/1962
Died: 4/14/2017
Camille Chandler
Born: 7/23/1947
Died: 4/10/2017
Juanita Duran
Born: 10/1/1950
Died: 4/9/2017
Jason Cirio
Born: 4/20/1983
Died: 4/7/2017
Rayford Starkey
Born: 8/13/1933
Died: 4/6/2017

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