Pre-Arrangement Form - CDN

Full Name*:

Email Address*:

Phone Number:

Full name of person whom these pre-arrangements are for*:

Note: Social Insurance Number is also required for some forms, but we will not take that information online. The number can be shared with the funeral home later either in person or over the phone.

The following information is used to complete relevant documentation at time of death

Date of Birth:

Place of Birth (town or city, and province. If outside of Canada, name of country):

Address (street number, street name, town or city, province, postal code):

Marital Status: (Single, married, common law or divorced):

If married, common law or divorced, Spouse’s name (including maiden name):

Occupation: (not retired, what the person did for most of their working career):

Father's Name:

Father’s place of birth: (town, city and province. If outside of Canada, the name the country. If unknown, type in unknown):

Mother’s name (including maiden name):

Mother’s place of birth: (town, city and province. If outside of Canada, the name the country. If unknown, type in unknown):

If YES

Is there a Will

Name of Executor(s):

Relationship to the person who’s pre-arrangements these are for:

Contact information Address:

Phone number:

Email address:

If NO

Name of person who will take responsibility for finalizing funeral arrangements:

Relationship to the person who’s pre-arrangements these are for:

Contact information: Address: (Street number and name, P.O. Box or Apt #, town or city, province and postal code):

Phone number:

Email address:

Disposition Information

I Prefer:

Cemetery:

do you have cemetery property, which cemetery Or if not, which cemetery would you consider

If Cremation, does the person who these pre-arrangements are for have

Pacemaker:

If Cremation, does the person who these pre-arrangements are for have

Radio active implants:

Plan of what to do with cremated remains: (i.e. burial in a cemetery, scattering, or kept by next of kin):

Examples.:       no visitation or service
visitation, private or public
                          funeral, private or public (preferred location)
celebration of life open house
                          graveside service (public or private)

Description of type of services seeking:

Please type in the space:

If a service requires someone to officiate, is there a clergy or officiant preference or church affiliation?:

Information that could appear in a death announcement, this information would be used to compose the notice. :

(Other option, a notice could be composed ahead of time and kept on file)
Examples of information to include in the box below:
- how the person’s name would appear
- spouse’s name, which could include maiden name and date of marriage
- family member names, including spouses
- work history, type of work, location and number of years
- volunteer involvement, hobbies, interests etc.
- preferred charities for memorial donations

i.e. Hymn or music preferences, pallbearers etc.:

Any other details for the funeral service you would want on file:

Do you want to meet with the funeral director do discuss pre-paying funeral arrangements?:

Please know that there is no obligation to pre-pay at any time.

This is a printable PDF file of information that is helpful for an executor or person responsible for the estate.

Printable PDF for Information

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Andrew L. Hodges Funeral Home Ltd.

47 Wellington Street South, PO Box 304
St. Marys, Ontario
N4X 1B2
Canada

Phone: 1 (519) 284-2820
Text: (519) 520-0478
Fax: 1 (855) 719-1796
Email: andrew@hodgesfuneralhome.ca

Pre-Arrangement Form - CDN

Person submitting this information

Andrew L. Hodges Funeral Home Ltd.

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