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Harkey Funeral Home
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Harkey 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:

 

NOTE:
Texas law requires sellers of prepaid funeral contracts to hold a permit issued by the Texas Department of Banking. For additional information regarding prepaid funeral contracts, go to the website located at: www.prepaidfunerals.texas.gov.

Matthew Blair
Born: 4/4/1980
Died: 1/20/2018
William Stewart
Born: 8/31/1932
Died: 1/17/2018
Marciano Diaz
Born: 1/11/1926
Died: 1/13/2018
Maria Sanchez
Born: 8/26/1933
Died: 1/13/2018
Maria Rodriguez
Born: 1/9/1920
Died: 1/11/2018
Michael Truex
Born: 7/12/1954
Died: 1/10/2018
Jose De La O
Born: 6/7/1926
Died: 1/7/2018
Estevan Orosco
Born: 5/15/1966
Died: 1/7/2018
Clifford Crouch
Born: 12/23/1948
Died: 1/6/2018

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Harkey Funeral Home | 210 S. Allen Ave. | Monahans, TX 79756 | 432-943-4407
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