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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.

Verda Robertson
Born: 12/3/1925
Died: 7/16/2017
Larry Martin
Born: 12/24/1922
Died: 7/14/2017
Genoveva Gonzales
Born: 6/11/1963
Died: 7/8/2017
Jose Flores
Born: 12/27/1926
Died: 7/8/2017
Javier Cardona
Born: 1/11/1961
Died: 7/7/2017
Ramon Carrasco
Born: 10/6/1923
Died: 7/6/2017
Clara Maddox
Born: 2/26/1921
Died: 6/30/2017
Clara Boreing
Born: 5/10/1917
Died: 6/26/2017
Dr. Barbara Hazlewood, Ph.d
Born: 3/15/1931
Died: 6/26/2017

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