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Rushing-Estes-Knowles Mortuary, Inc.
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Rushing-Estes-Knowles Mortuary, Inc..
*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.

Antonia Aguilera
Born: 9/21/1916
Died: 4/28/2017
Verle Buller
Born: 12/23/1939
Died: 4/22/2017
Lucilla Chavera
Born: 6/18/1946
Died: 4/22/2017
Patricio Granado, Sr.
Born: 8/30/1951
Died: 4/21/2017
Edward Gomez
Born: 2/13/1992
Died: 4/20/2017
Juanita Lopez
Born: 9/23/1944
Died: 4/20/2017
Patricia Berry
Born: 4/27/1920
Died: 4/18/2017
Jose Medina
Born: 10/8/1939
Died: 4/18/2017
Jesusita Vasquez
Born: 10/29/1950
Died: 4/18/2017

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