903 S. Ohio ~ Sedalia, MO 65301 ~ (660) 826-1750 ~ info@heckart-gillespie.com
Have you been thinking about pre-arranging your funeral? If so, there is no easier, more convenient way to do it than filling out this form. This guide includes most of the information we would normally gather in a pre-arrangement conference.
You have two options to use the form:
(1) At the end of the form, if you click "submit," your information will be sent to Heckart/Gillespie Funeral Home for safekeeping.
(2) At the end of the form, you may choose to print the information and keep it for yourself. As long as you don't click "submit" the information will not be transferred to anyone. It will be seen only by you.
Warning: If you close the browser window, your information will be lost.
First Name
Middle
Last Name
Maiden Name or Sr., Jr., etc.
Mailing Address
Number of Years at This Address
City
State
Zip Code
Phone Number
Date of Birth
Place of Birth
Name of Spouse (if applicable) (include maiden name if applicable)
Date of Marriage
Place of Marriage
Is your spouse living?
Spouse's Date of Death (if applicable)
Your Occupation (include your title and type of business or industry)
Are you retired?
Retirement Date
Father's Full Name
Mother's Full Name (maiden)
Education (highest grade or number of college years completed)
Are you a veteran?
Branch of Service
Date Enlisted
If you served in a war, which one?
"C" Number
Service Number
Highest Rank
Date Discharged
Location of Discharge Papers
Name of Church or Place of Worship
Church or Place of Worship Activities (include positions, committees, etc.
Other Memberships (organizations, clubs, lodges, etc.)
(include children, grandchildren, great grandchildren, brothers, sisters, etc.)
Those Whom Have Preceded You in Death
Service Details
Preferred Place of Service
Clergyperson or Reader Officiating
Others to Participate
Pallbearers (usually six)
Honorary Pallbearers (any number)
Music Selections / Readings
Memorial Contributions to:
Cemetery
Cemetery Lot in the Name of:
Any Other Comments
Disclaimer: This is not a secure site. Due to the lack of internet security, once you click "submit," Heckart/Gillespie Funeral Home cannot guarantee the privacy your information.
Option 1
Submit this information to us for safekeeping.
We will keep this information confidential.
We recommend that you also print your information first for your own records.
In order to finalize these pre-arrangements, we need to contact you personally. May we contact you?
If so, how would you prefer to be contacted?
Option 2
Print this information for your records. (Click File>Print in this browser window)
If you choose this option, your information will not
be submitted to Heckart/Gillespie.
Please tell your family where you plan to keep this information.
