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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.

Nancy Molina
Born: 8/24/1975
Died: 5/22/2017
Cynthia Hood
Born: 7/18/1968
Died: 5/17/2017
Eliberto Franco, Jr.
Born: 2/4/1965
Died: 4/21/2017
George Bentley, Jr.
Born: 1/1/1900
Died: 4/16/2017
Pedro Parras
Born: 8/2/1928
Died: 3/31/2017
Blanche Winterburn
Born: 1/1/1900
Died: 3/31/2017
Ventura Herrera
Born: 7/14/1931
Died: 3/30/2017
Gloria Burgess
Born: 4/16/1927
Died: 3/17/2017
Mary-Alice Neilson
Born: 12/29/1923
Died: 3/9/2017

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