Advance planning checklist

To start, fill out this form to prearrange your funeral needs.

Also check out our list of important documents to help you keep track of these at any time, not just when planning or coping with a funeral.

This online form and lists provide a good starting place, but they don't do it all. Talking about your thoughts and plans with a funeral preplanning consultant will help you understand how the information is used and what is needed for a complete plan. Your funeral preplanning should be filed with a funeral home so that it can be easily located and followed in the event of your death. Randy Sietsema or Tony Hinners can assist you in preplanning funeral arrangements. Please contact us for more information, by phone (641-648-9554 ), e-mail rsietsema@mchsi.com, or through this form.

When you click on the button to submit the form, it will be sent to us. We will print it and mail a copy to you, and we will call you to follow up on this form, to clarify the information, and to answer any questions that you may have. Please indicate the best time for us to call you.

No online or paper form can complete your funeral preplanning. It is important to discuss your plans and to completely explain your wishes, and it is important to file this information with a funeral home so that your wishes can be found and followed.

Vital Statistics

These vital statistics are needed for the death certificate, obituaries, permits and authorizations, benefit papers (Social Security, military), and other paperwork that funeral directors do.

First Name
Middle Name
Last Name
Address
City
State
Zipcode
Date of birth
Place of birth
County of Birth
Social Security number
High School
Number of years attended
College
Number of years attended
Primary occupation
Primary employer (longest or last)
Retired?
Type of business
Marital status	Never Married Married Divorced Separated Widowed
Spouse's full maiden name
Date of Marriage
Place of Marriage
Father's full name
Mother's full maiden name
Please list any organizations or special activities involved in.
Please list any surviving relatives, including spouses names, relationship,and where they are from, that you would like included in obituary.
Number of Grandchildren? If you wish them listed by name please add to survivors above.
Number of Great-Grandchildren
Preceded in death by:

Military Records

Branch of military
Date of induction
Date of discharge
Rank at discharge
Serial number
War/conflict

Ceremony wishes

Visitation, with or without viewing? Would you like the visitation in our chapel or at a church?
Which funeral home location would you prefer?	Surls Funeral Home in Iowa Falls Surls Funeral Home in Alden Surls Funeral Home in Williams Sietsema Funeral Home in Ackley
Religious preference
Minister
Please list any special scriptures or poems you would like read.
Place of Funeral Service
Flowers: Do you want us to order flowers? Which florist?
Memorials may be directed to whom?
Music: What songs would you like during the service?
Organist
Soloist
Other: Think about a photograph display or memorial table.
Casketbearers, Please include a phone number if you have one.
Car Drivers, Please include phone numbers if you have them.
Would you like us to contact the casketbearers and car drivers?
Would you like a lunch after the service?

Final disposition

Burial, Name of Cemetery?
Cremation
	Cremated remains should be Kept in urn at home? Burial at cemetery?

Person in charge of arrangements

Name
Relationship
Address
City
State
Zip
Phone Number

Additional Thoughts

Follow up

Our preplanning consultant will call you to follow up on this form and answer your questions. When would be the best time to call?

Best time to call:

Telephone number: