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O'Connell Family Funeral Homes - Winner of the NFDA Pursuit of Excellence Award. Learn More About This Award

Pre-planning Form

The O'Connells have prepared the following questions to assist you with the pre-planning process. These are some of the basic biographical and informational questions that would come up when making arrangements. You can fill out this form and print it for your records and also keep a copy with us by hitting the Submit button. All the information will remain STRICTLY confidential.
Full name:
Street Address:
City:
   State:    ZIP:
Phone:
 - -
 
Social security number:
 - -
Date of birth:
Place of birth:
Father's complete name:
Mother's complete name:
   Maiden name:
 
Place of elementary education:
Place of high school education:
Place of college education:
Main occupation during life:
Primary employer:
Interests and hobbies:
Organizations:
 
Spouse's complete name:
   Maiden name:
Date of marriage:
Place of marriage:
Church denomination:
Location of church:
Type of service selected:
Cemetery location:
 
Are you a veteran?
Next of kin:
Special instructions or notes
to the O'Connells:

Do you wish to be contacted by phone or e-mail?
 
   E-mail address:
Can we send you a free no obligation advanced
planning guide?