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308-633-5763

stefanie@reverencefuneralparlor.com

308-633-5763

OBITUARIES

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Online Preplanning Form

Receive Alerts as We Post Tributes

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Personal Information

Who is this plan for?

First Name

Middle Name

Last Name

Address

County

Within City Limits

Yes

No

Date of Birth

Place of Birth

Sex

Male

Female

Race

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Contact Information

First Name

Last Name

Email Address

Phone Number

Interest

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Family, Work, & Education

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Family Information

Father's Name

Mother's Name

Mother's Maiden Name

Marital Status

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Date of Marriage

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Additional Family Members

Siblings (alive)

Siblings (deceased)

Children (alive)

Children (deceased)

Grandchildren (alive)

Grandchildren (deceased)

Great-Grandchildren (alive)

Great-Grandchildren (deceased)

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Education History

School Name

Highest Level of Education

School Location

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Work History

Occupation

Company Name

Years At Company

Did this person serve in the military?

Yes

No

If so, Which Branch?

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Your Wishes

Visitation Options

Visitation at funeral home

Visitation elsewhere

No Visitation

Funeral Service Option

Funeral service at funeral home

Funeral service elsewhere

No Visitation

Reception Options

Reception at funeral home

Reception elsewhere

No Visitation

If you chose visitation elsewhere, where?

If you chose funeral service elsewhere, where?

If you chose reception elsewhere, where?

Would you prefer burial or cremation?

Burial

Cremation

Final Disposition

Ground Interment (burial) radio

Mausoleum Entombment (above ground burial) radio

Columbarium (for cremation urns) radio

Ashes returned to family radio

Would you prefer to include a graveside/committal service?

Yes

No

Which Cemetery

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Your Preferences

Please list any musical selections you would like to include in your services.

Please list any special themes, hobbies, or colors you would like to include in your services.

Please list any poems, religious texts, or readings you would like to be read at your services.

Celebrant or Official I would like to lead the service

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2002 Char Ave, Scottsbluff, NE 69361

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