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Alpine Memorial Funeral Home
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Alpine Memorial Funeral Home.
*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:

 

NOTE:
Texas law requires sellers of prepaid funeral contracts to hold a permit issued by the Texas Department of Banking. For additional information regarding prepaid funeral contracts, go to the website located at: www.prepaidfunerals.texas.gov.

Isabel Garcia
Born: 3/24/1929
Died: 9/9/2017
Petra Orozco
Born: 2/23/1938
Died: 9/3/2017
David Covarrubias
Born: 11/18/1958
Died: 9/1/2017
Ernestina Hernandez
Born: 10/1/1929
Died: 8/16/2017
Rev. H. Eugene Myrick
Born: 9/9/1927
Died: 8/12/2017
Hortencia Hendrix
Born: 8/28/1926
Died: 7/27/2017
William Sprinkle, Jr.
Born: 3/1/1945
Died: 7/22/2017
Juan Nunez
Born: 1/15/1957
Died: 7/21/2017
Verda Robertson
Born: 12/3/1925
Died: 7/16/2017

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Alpine Memorial Funeral Home | 209 West Sul Ross Ave | Alpine, TX 79831 | (432) 837-2222
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