Halverson Funeral Home Pre-Needs FormHalverson Funeral Home Office

"The option that relieves the burden from your family"

One of the most loving, caring things that an individual can do is to leave behind details and information in regards to Pre-Planning. If you feel it is too hard to discuss funeral arrangements at this time, just think how difficult it would be for your loved ones at a time of loss.

Advantages of Planning Your Funeral Arrangements

• Pre-Planning will express your wishes.

• Pre-Planning relieves your family from making difficult decisions at a time of sorrow.

• Pre-Planning will give you and your family the security and satisfaction knowing
that all the arrangements have been planned and paid for.

If you are ready to begin the Pre-Planning process please call Robert H. Halverson Funeral Home at 814.445.5932,
or complete the form below and we will contact you.

Arrangements for:
Current Address (street, city, state, zip, county):
Date of Birth:
Place of Birth (city, twp, state):
Spouses Name (If wife, Maiden Name):
If spouse is deceased, give date of death:
Fathers Name:
Mothers Name (Include Maiden Name):
Veteran:
If Yes, location of discharge:
Social Security Number:
Highest Grade of Education:
Occupation:
Employer:
Number of Years:
Date of Retirement:
Church Membership:
Minister:
Memberships, Clubs or Organizations (List all):
Public Viewing:
Visitation Hours:
Place of Funeral Service (Church or Funeral Home):
Final Disposition:
Cemetery Name:
Is a Stone or Marker in place:
Memorial Contributions, if desired:
Next of Kin or person who will be in charge of arrangements (relation):
Name:
Address (street, city, state, zip, county):
Telephone Number:

Deceased Family Members Section

Spouse:
Parents:
Children:
Grandchildren:
Brothers:
Sisters:

Surviving Family Members Section

Name and Address of Surviving Spouse (name, city, state):
Name and Address of Surviving Parents (name, city, state):
Name and Address of Surviving Children (name, city, state) (Add a line for each person):
Grandchildren (Names and Phone Number):
Great Grandchildren (Names and Phone Number):
Brother and Sisters (Name and Address) Separate on new line:
Other requests or information:
Email Address:

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