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HOME
SERVICES
PLANNING AHEAD
ABOUT US
OBITUARIES
GRIEF SUPPORT
RESOURCES

AVAILABLE 24/7 (707) 462-2206

Planning Ahead

Online Preplanning Form

Online Preplanning Form

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Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

Date of Birth

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About You

Email Address

Phone Number

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Family, Work, & Education

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Family Information

Father's Name

Father's State of Birth

Mother's Name

Mother's State of Birth

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

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Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

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Education History

School Name

Highest Level of Education

School Location

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Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

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Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Funeral Service

Reception Options

Reception at funeral home

Reception elsewhere

No Reception

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial)

Mausoleum Entombment (above ground burial)

Columbarium (for cremation urns)

Ashes returned to family

Would you prefer to include a graveside/committal service?

Yes

No

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Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Please list any interests or hobbies you would like to include into your services.

Is there a special story, personal thank you, or message of hope you would like to be read during your services?

Would you like someone to contact you to finish these arrangements?

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if yes

Name

Phone

Email

Thank you for contacting us.
We will get back to you as soon as possible.

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Eversole Mortuary

Ukiah, CA 95482

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