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Pre-Arrangements Form


Pre-Arrangement Details

Personal Information of person filling out form

PERSONAL INFORMATION FOR BENEFICIARY OF PREARRANGEMENT

Please use the area above to enter the names of surviving spouse, children, grandchildren, and siblings.

Work/Education History

Please check highest level completed
Please use this space for other work related information
Please list all memberships here
Please list all other hobbies and enjoyments here

Military Record

Funeral Service Request

If church is selected for place of service please enter name and location

Disposition Request

(if applicable)
(if applicable)
(if applicable)

Summary Details

Use this form to provide us with as much or as little detail as you wish.  At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Schroder Mortuary - Silvis
|
701 1st Avenue
| Silvis, IL 61282
|
Tel: 1-309-755-2212
Schroder Mortuary - Colona
|
213 1st St.
| Colona, IL 61241
|
Tel: 1-309-792-1633
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