Pre-Planning Form - Byers Funeral Home

Name*
First Middle Current Surname
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Marital Status:*
- Single
- Common Law
- Married
- Widowed
- Divorced
Name of Spouse or Partner
First Middle Last
Occupation (when working)*
Mother's Name*
First Name Maiden Name
Mother's Birthplace*
Father's Name*
First Last
Father's Birthplace*
I wish my funeral to be:*
- Public
- Private
I wish for my services to be held at:*
My preference for burial arrangements and other instructions:*
My church affiliation is:
I would prefer as clergyman:
Please list any other instructions or remarks:
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