Beinhauer Funeral Home

First Name:

Middle Name:

Last Name:

Gender:  Male Female

Your Information:

First Name:

Middle Name:

Last Name:

Daytime Phone*:

Evening Phone:

Email*:

Next

Biographical Information:

Birth Date:

Birth Place:

Family Information:

Marital Status:  Married Single Widowed Divorced

Father's Name:

Address - If Living:

Mother's Name:

Address - If Living:

Siblings (Living):

Siblings (Deceased):

Children (Living):

Children (Deceased):

Grandchildren (Living):

Grandchildren (Deceased):

Great Grandchildren (Living):

Great Grandchildren (Deceased):

Education & Work:

Highest Level of Education:

School Name:

School Location:

Occupation:

Company:

Years at Company:

Military Service:

Military Service:  Yes No

Prev Next

Visitation Options:

 Visitation at funeral home. I do not wish to have visitation hours.

Other:

Funeral Service Options:

 Funeral Service at funeral home. I do not wish to have a funeral service.

Other:

Reception Options:

 Reception at funeral home. I do not wish to have a reception.

Other:

Would you prefer burial or cremation:

 Burial Cremation

Final Disposition:

 Ground Interment (burial) Mausoleum Entombment (above ground burial) Columbarium (for cremation urns) Cremated body returned to family

Would you prefer to include a graveside/committal service?

 Yes No

Prev Next

Please list any musical selections you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any interests or hobbies you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any specific foods or beverages you would like to make available to your family and guests at the services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Prev