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Emergency Record Guide
Following is a useful form to gather all of the necessary information to begin pre-planning final arrangements. Feel free to print this form and use it for your records. Be sure to place the completed form in a place where family and friends will know to look in case they should need it. Never place final arrangement information in a safe deposit box, as such boxes are rarely accessed before final arrangements need to be made.
Name (Last, First, MI)
Current Address (street address)
(City, State, Zip)
Date of Birth
January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 31 29 30 , 18 19 20 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99
Place of Birth (City, State,)
Social Security Number
Father's Name
Mother's Name (maiden)
VETERAN INFORMATION
Army Navy Air Force Marines Coast Guard
Date Entered Military
Place of Enlistment
Date Discharged
Place of Discharge
Highest Rank Achieved
Service Number
Organization
Location of Discharge Papers - DD214
A copy of discharge papers (DD 214) are needed for burial in a National cemetery.
FAMILY INFORMATION
Survivors (Spouse, Children, Brothers, Sisters, Parents, Grandchildren)
Organizations, Memberships, Church Affiliations
Biographical Sketch
SERVICE INFORMATION
Place of Service
Visitation Yes No
If yes, location
Method of Final Disposition
Burial Cremation
Casket View Caskets
Atlantic Blue Brushed Copper Burgundy Burgundy Silver Butler Coral Mist Diamond Blue Gold Blend Gray Hyacint Light Nutmeg Milford Pewter Praries Solid Oak Sierra Pine Spartan Blue Spartan Bronze White Walnut Woodstock Oak
Vault View Vaults
Wilbert Bronze Bronze Triune Copper Triune SST Triune Cameo Rose Venetian Continental Monticello Grave Liner
Cemetery
Pallbearers
Honorary Pallbearers
Clergy
Organist
Vocalist
Musical Selections
Newspapers used for obituary
Pioneer Review
Pennington Co. Courant
Kadoka Press
Rapid City Journal
Sioux Falls Argus Leader
Pierre Capitol Journal
Other Newspaper(s)
Additional Instructions or Concerns
After you submit this form, we will respond to any questions you may have as well as a detailed list of all charges for the services you have chosen.
How do you want to receive this information?
e-mail phone person to person
E-mail Address
Phone Number
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