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Escude Funeral Home
EASY FUNERAL PRE-PLANNING FORM
 

To be placed in the permanent files of Escude Funeral Home.
*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:

 
Jeanette Fields
Born: 11/1/1960
Died: 6/22/2017
Connie Ducote
Born: 8/4/1946
Died: 6/17/2017
Jolene Perryman
Born: 4/18/1942
Died: 6/13/2017
Nina Joffrion
Born: 7/24/1927
Died: 6/12/2017
Annie Sherman
Born: 12/9/1922
Died: 6/9/2017
Will Johnson
Born: 1/15/1938
Died: 6/4/2017
Roy Laborde, Sr.
Born: 3/12/1938
Died: 5/31/2017
Ronald Lemoine
Born: 7/21/1944
Died: 5/31/2017
Maureen Barr
Born: 4/28/1952
Died: 5/30/2017

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