Obituaries
& Tributes

(916) 797-1448
Immediate Need

Pre-Arrange
Your Funeral

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Us

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Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Obituaries & Tributes

It is not always possible to pay respects in person, so we hope that this small token will help.

Pre-Arrangement

A gift to your family, sparing them hard decisions at an emotional time.

Order Flowers

Offer a gift of comfort and beauty to a family suffering from loss.

Pre-Planning Online

One of the most caring, loving things you can do for your family is to leave detailed information which permits them to make the funeral service a personal tribute in keeping with the way you wanted.

By providing the personal information below, we will set up a Secure File for you. This is the first step in making your advance funeral plan. Some of this information is necessary for the completion of the California Certificate of Death when the time comes, and some is a way to help you think through what your wishes might be. At the end of the form, you will let us know how you would like to proceed.

I. Biographical Information
Full Name:
Address1:
Address2:
City:
State:
Zip Code:
Telephone Number: (xxx-xxx- xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's State or Country of Birth:
Mother's Name:
Mother's State or Country of Birth:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded You In Death
Your Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record
Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:

Please send me information

Please contact me to schedule an appointment

Please place my information on file


 

 

 

 

 

 

 

 

Proudly Serving the Communities of Roseville, Sacramento, Rocklin, West Sacramento, Lincoln, Auburn, Loomis, Granite Bay, North Highlands, Orangevale, Citrus Heights, Folsom, Antelope, Newcastle, Penryn, Applegate, and Colfax

(916) 797-1448 97 Vernon St. | Roseville, CA 95678 | FD-1671 | Fax: (916) 797-2002 | Email: info1@chapelofthevalley.com