Osborn Funeral Home, Inc.

"The option that relieves the burden from your family."

One of the most loving, caring things that an individual can do is to leave behind details and information in regards to Pre-Planning. If you feel it is too hard to discuss funeral arrangements at this time, just think how difficult it would be for your loved ones at a time of loss.

Advantages of Planning Your Funeral Arrangements

If you are ready to begin the Pre-Planning process,
please call Osborn Funeral Home at 618-266-7231 or complete the form below.

Personal Information
Name (First MI Last):
Marital Status:
Birth Date:		Birth Place:
Current Address:
City:		State:
Zip:		County:
Phone:
E-mail:
Spouse's Name:
Spouse's Maiden Name:
Marriage Date:		Marriage Place:
Father's Name:
Mother's Name:
Mother's Maiden Name:
Person in Charge:
Address:
Phone:
Work/Education History
Education (0-12):		College 1-5+:
Occupation:
Business:		Company:
Military Record
Branch of Service:
Serial Number:
Date Enlisted:		Date Discharged:
Rank At Discharge:
Discharge On File At:
Copy of Discharge Papers:		Yes No
Name Of Wars:
Funeral Service Request
Place Of Service:
Funeral Home:
Address:
Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Newspaper Information (Please list family members)
Children:
Brothers/Sisters:
Number of Grandchildren:
Other significant relatives:
Special Instructions
Lodges and Organizations:
Jewelry:
Glasses:
Lodge / Union:
Clothing Preference:		My own Other
Disposition Request
I Prefer:
Cemetery:
Address:
Phone:
Section:
Last will and testament exists:		Yes No
Location:

Other Instructions
Memorials/Donations To Charity
Please select all that apply: Send information about pre-arrangement Contact me to set an appointment Please keep my information on file