Preston-Hanley Funeral Homes & Crematory

Compiling History

Compiling History

Ease the burden for your family... make your wishes known.

By planning ahead now, you will be ensuring that those you love will never have to make these decisions without your input, during a time of grief.  Simply fill out the form below and submit to Preston-Hanley for safekeeping in our fire-protected safe. You can also print out the details and keep the copy with your personal records.

 

Required fields are marked with a

Vital Statistics Record

First Name
Middle Name
Last Name
Street Address

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City
State
Zip Code
Country
Home Phone
Work Phone
Mobile Phone
Email Address (Home)
Birthplace
Birth Date
Father's Full Name
Mother's Name (with Maiden name)
Marital Status
Married
Divorced
Single
Widowed
Spouse
Marriage Date
Marriage Place
If Deceased when? (if applicable)
Spouse #2
Marriage Date
Marriage Place
If Deceased when? (if applicable)
Doctor's Name
Doctor's Address

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Doctor's Phone

Personal History

Occupation
Employer
Position Held
How Long (Dates - m/y - m/y)
Retired
Yes
No
Retired When (m/y)
Resident Cities & Years

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Education

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Military Experience

War(s)
Rate or Rank

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Entry Date(s) & Place(s)

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Service Number(s)

Other Personal Information

Lodges, Memberships, Church & Public Offices Held

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General Biography for Media & Funeral Service

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We will notify The Peoria Jornal Star and Pekin Daily Times. Is there any other newspapers you would like us to notify?

Immediate Family Information

Name & Relationship, City & State

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Preceded iin Death By

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Local Emergency Contacts to be Notified at Need

Name - Address & Phone #1

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Name - Address & Phone #2
Name - Address & Phone #3

Legal Information for Family Use

Will
Attorney
Safe Deposit Box At
Executor of Estate (with address)

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Any Additional Pertinent Information

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Funeral Service Instructions & Information

Place of Service
Funeral Home/Chapel
Church
Graveside Only
Type of Disposition
Cremation
Burial
Mausoleum Entombment
Cemetery
Location
Section
Lot
Space
Marker Installed
Remarks

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Clergy
Church
Organist
Vocalist
Music Selections

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Favorite Bible Passages, Poetry, Quotations, Verses, etc

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Flower Requests
Clothing
New
Present
Color
Jewelry
Decision of Clothing & Jewelry to be made by
Participating Organizations

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Pallbearer & City
Pallbearer & City
Pallbearer & City
Pallbearer & City
Pallbearer & City
Pallbearer & City
Alternates/Honorary

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I have given the preceding information to be filed confidentially with Preston-Hanley Funeral Home in order to avoid placing all responsibility on family and loved ones at the time of my death.
I agree
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