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Stevens Funeral Home
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Stevens Funeral Home.
*Require fields

Person Completing this Form*:
Relationship*:
Email*:
 
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
Address:
(no P.O. Box)
City:
State:
Zip:
Date of Birth:
(mm/dd/yyyy)
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Degree:
Veteran: Yes No
Military Branch:
Dates of Service:
Occupation:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
 
Family Member Information

Family Member #1

 
Funeral Arrangement Details
Person in charge of arrangements:
 
Place of service or gathering:
If Other, please specify:

 

Preference for final disposition:
If Other, please specify:
Cemetery:
Disposition of cremated body:
 

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?

 

Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

  security code
Enter Security Code:

 
Myrna Olivas
Born: 7/19/1977
Died: 4/23/2017
Charles Frazier
Born: 8/16/1935
Died: 4/11/2017
Charles Robinson
Born: 10/20/1929
Died: 1/14/2017
Benjamin Quiroz
Born: 4/18/1931
Died: 1/8/2017
Leonor Contreras
Born: 7/3/1943
Died: 11/17/2016
Christopher Phillips
Born: 8/23/1993
Died: 11/15/2016
Wealtha Burt
Born: 7/5/1930
Died: 11/14/2016
Jimmy Altman
Born: 12/3/1942
Died: 10/22/2016
Gerald McBride
Born: 7/20/1945
Died: 10/14/2016

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Stevens Funeral Home | 1106 N. Main Avenue | Lovington, NM 88260 | 575-396-8081
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