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Victory Funeral Services

Providing heartfelt services with dignity

Funeral Pre-Planning Form

This Funeral Pre-Planner Form allows you to submit your information directly to Victory Funeral Services to be held in our files until your time of need. Sharing this information with the person that will be the responsible party at the time of your demise would be beneficial. Make sure they have your social security number as well if you choose not to leave it here.

Date:

Name (first, middle and last; AKA's if any):

Maiden Name:

Sex:

FemaleMale

Date of Birth:

Security Number:

Driver's License Number:

Marital Status:

MarriedNever MarriedDivorcedWidowedUnknown

Address:

City:

State and Zip Code:

Inside City Limits?:

YesNo

Home Phone:

Cell Phone Number:

Fax Phone Number:

Birthplace (city and state or foreign country; not county):

Surviving Spouse (if wife, give name prior to first marriage)

Father's Name (first, middle, last)

Mother's Maiden Name:

Education (check box that best describes highest degree or level of school)

8th grade or less9th - 12th grade, no diplomaHigh school graduate or GED completedSome college credit, but no degreeAssociate degree (e.g., AA, AS)Bachelor's degree (e.g., BA, AB, BS)Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA)Doctorate (e.g. PhD, EdD or MD, DDS, DVM, LLB, JD)

Race:

Black or African AmericanWhiteHispanic OriginAmerican Indian or Alaska NativeChineseAsian IndianOther

Ever a peace officer in Texas?:

YesNo

Usual occupation (indicate type work during working life; do not use retired:

Type of Business/Industry:

Ever in the U. S. Armed Forces?:

YesNo

Name of organization in which service was rendered:

ArmyNavyAir ForceMarinesCoast GuardArmy National GuardArmy ReserveMarine Corps Forces ReservNavy ReserveAir National GuardAir Force ReserveCoast Guard Reserve

Serial number of discharge papers or adjusted service certificate:

Name of next of kin or next friend:

Address:

Date Entered Service:

Place Entered Service:

Grade or Rank:

Company, Regiment or Division:

Name of War or Conflict:

Date of Discharge:

Place of Discharge:

Decorations:

Special Instructions:

Medal of Honor Recipient:

YesNo

Flag should be given to:

Veterans Cemetery Marker:

Marble UprightMarble FlatGranite UprightGranite FlatBronze Flat

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Thank you! Your information has been submitted successfully. You've made a very important decision. We will be in contact with you shortly.

Continue to the next page of this form to finalize your wishes.

Victory Funeral Services, 1004 Martin Luther King Drive, Kilgore, TX 75662 - 903-988-1122 phone 903-234-0511 fax -- [email protected]

Home
About Us
VFS Staff
At The Time of Need
Funeral Pre-Planning Form Pg 1
Funeral Pre-Planning Form Pg 2
Funeral FAQ
Veteran's Benefits
Veteran's DD-214
Caskets
Obituaries
Signature Services Available
The Victory Stone and QR Code
LifeMarker QR Codes
Photo and Video Gallery
Contact Us

Home
About Us
VFS Staff
At The Time of Need
Funeral Pre-Planning Form Pg 1
Funeral Pre-Planning Form Pg 2
Funeral FAQ
Veteran's Benefits
Veteran's DD-214
Caskets
Obituaries
Signature Services Available
The Victory Stone and QR Code
LifeMarker QR Codes
Photo and Video Gallery
Contact Us

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