LADUSAU-EVANS
FUNERAL HOME
2800 N VAN BUREN
ENID, OKLAHOMA
73703
580-233-1400
ladusauevans
@suddenlinkmail.com
Pre-Need Form
Personal Information
Full Name
City
Address
County
Zipcode
State
Phone
E-Mail
Vital Information About the Person for Whom Pre-Arranging is
Being Done
Full Name
Single
Marital Status
 Married
 Divorced
 Widowed
Sex
 Male
Female
Social Security #
 Date of Birth
Place of Birth
Spouse's
Name
Spouse's Maiden
Name
Place of
Marriage
Date of
Marriage
Father's
Name
Mother's
Name
Mother's
Maiden Name
Work/Education History
Education (0-12)
 College 1-5+
Schools Attended
Occupation
Industry
Military Record
Branch of
Service
Serial
Number
Date
Enlisted
Rank at
Discharge
Date
Discharged
Copy of
Discharge
Papers
Yes
No
Name of Wars
Funeral Service Request
Place of Service
Funeral Home
Visitation
Yes
No
Graveside
Church
Name of Place of
Service
Person(s) To Finalize Arrangements At Time of Death:
Check here and skip this section if the person filling out this online form is also
making the final arrangements.
Full Name:
Address
County
City
State
Zipcode
Phone
E-Mail
Special Instructions:
Flower Preference
Music
Casket Bearers (x6)
Jewelry
Glasses
Clothing
Other
Disposition Request
I Prefer
Burial
Cremation
Cemetery
       
Memorials/Donations to Charity
Newspaper Information
(Please list family members)
Spouse
Parents
Children
Grandchildren
Great
Grandchildren
List any other
significant
relatives
Brothers/
Sisters
Please Select all that Apply
Send Information about pre-arrangement
Contact me to set an appointment
Please keep my information on file