Pre-Planning Form

Ronald Hornyak

William Brice

Victor Louis

Kelley-Robb-Cummins Funeral Home
709 N Main St.
Hubbard, OH 44425
330-534-1952

Pre-Planning Form

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral service a personal tribute in keeping with the way you wanted. Making funeral arrangements at the time of loss is extremely difficult for those left behind. When the funeral, and sometimes even payment, have been arranged in advance, most of the decisions have been made, sparing uncertainty and confusion at a time when emotional stress may make decisions difficult. Would it be better in your situation to plan ahead, calmly and sensibly, when you are in a normal mental and physical state, when you have full ability to reason, and when you are able to discuss arrangements with your family? You may file vital statistic and preferred funeral information with us on-line by filling in the following information:

I am planning for:
Personal Information
Name:
Email Address:
Address:
City:
State/Province:
Country:
Zip Code:
Phone Number:
Place of Birth:
Date of Birth:
Sex:
Citizenship:
Marital Status:
Spouse (Maidenn Name):
Father's Name:
Mother's Maiden Name:
SSN:
Religous Preference:
Education
High School Name:
# of Years:
College Name:
# of Years::
Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)
Survivors:
Preceded in Death by::
Additional Information and Organ:
Work History
Occupation:
Business:
Industry:
Company:
Number of Years:
Years Retired:
Military Service
Service Branch:
Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge on File At:
Combat Action:
Funeral Preferences
I prefer my Funeral Service to be
Public:
Private:
Visitation
Public:
Private:
Place of Service:
Other:
I prefer
Cremation:
Burial:
Entombment:

For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.

Pre-Planning Form

I am planning for:
Personal Information
Name:
Email Address:
Address:
City:
State/Province:
Country:
Zip Code:
Phone Number:
Place of Birth:
Date of Birth:
Sex:
Citizenship:
Marital Status:
Spouse (Maidenn Name):
Father's Name:
Mother's Maiden Name:
SSN:
Religous Preference:
Education
High School Name:
# of Years:
College Name:
# of Years::
Family Information: Please list the names of survivors and state their relationship to you, their spouse's names and the city in which they live as you wish to have them listed in the memorial. (The following is a guide to assist you.) SURVIVORS: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Grandchildren, (Great-grandchildren), Grandparents, Others (Eg. Son: Joe Smith and his wife Paula of Milledgeville)
Survivors:
Preceded in Death by::
Additional Information and Organ:
Work History
Occupation:
Business:
Industry:
Company:
Number of Years:
Years Retired:
Military Service
Service Branch:
Serial Number:
Date Enlisted:
Rank at Discharge:
Date Discharged:
Discharge on File At:
Combat Action:
Funeral Preferences
I prefer my Funeral Service to be
Public:
Private:
Visitation
Public:
Private:
Place of Service:
Other:
I prefer
Cremation:
Burial:
Entombment:

For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.