THOMPSONMILLER FUNERAL HOME INC 124 EAST NORTH STREET BUTLER

Thompson-Miller Funeral Home, Inc

Thompson-Miller Funeral Home, Inc.

124 East North Street, Butler, Pennsylvania 16001

Glenn T. Miller, Supervisor

724-287-3706 (office) [email protected] 724-287-3705 (fax)

Pre-Arrangement Fact Sheet

The following information is needed at the time of your pre-arrangement meeting.

Please Print

Full Name Nickname Age

Address

City State Zip

Township County

Social Security number

Where were you born?

Birth date

Father’s name

Mother’s name (with maiden name)

Work History

Where did you work?

If you are retired, what date?

Spouse’s Name

Date you were married

Date of death, if your spouse is deceased

Are you a member of a church?

Name of Church

Do you belong to any Organizations/Community Activities/Clubs? Please list:

What are your interests or hobbies? Please list:

Education:

High School you attended

How many years did you attend?

College you attended

How many years did you attend?

What degree did you receive?

Military:

Were you in the Military?

What branch

Rank when you were discharged

Did you serve during peace time/war time?

Where did you serve?

Are you able to find your discharge papers? (DD-214)

(The funeral home will need a copy)

Survivors: (Please also indicate the city and state in which they live)

Spouse/Parents/Children/Grand-children/Brothers/Sisters/Nieces/Nephews

Spouse:  surviving
Parents:  surviving
Sons: City & State	Brothers City & State




	Sisters City & State
Daughters: City & State



	Brother-in-laws & Sister-in-laws

Grandchildren (the number of or list by name)


	Nieces (the number of or list by name)


Great-Grandchildren (the number of/ or list by name)
	Nephews (the number of or list by name)



Preceded in death:

Funeral Service:

Where would you like the funeral service to be held? Church or Funeral Home

What pastor/lay-minister would you like to perform the service?

What church is the pastor/lay-minister from?

Cemetery:

Cemetery name

Do you own space/spaces there?

Will you be buried beside someone?

Memorials:

Who should memorial donations be made to?

Is this in lieu of flowers? Yes _____ No _____

Contact Person and/or who will be next of kin at the time of need:

Name relationship

Address phone #

Social Security number

Please call to schedule an appointment at your convenience

Thompson-Miller Funeral Home, Inc.

124 East North Street, Butler, Pennsylvania 16001

724-287-3706 (office) [email protected] 724-287-3705 (fax)

Tags: thompsonmiller, butler, street, funeral, north