Decedent Information:

Date of Birth
Birth Place

Decedent’s Usual Residence:

Informant:

Decedent’s Surviving Spouse & Parents:

Birthplace of Father:
Birthplace of Mother:

Final Disposition:

Place of Death:

Decedent’s Attending Physician:

Type of Services:

We Have Reserved:

For your appointment to make Funeral Service Arrangements at the

Chapel of the Highlands

  • If you are unable to keep the above appointment, please call our office;
  • If an appointment has not been made, we will contact you and arrange for one;
  • If you wish, you may call us after 9:00 AM to arrange for an appointment;
  • It is important that you are on time for your appointment. We have set this time aside so we may better
    serve you.

Kindly fill in any additional information that would be of assistance to your Funeral Counselor

~ Survivors: Spouse, Sons, Daughters, Parents, Brothers, Sisters, Number of Grandchildren, etc.

Helpful Information and Advice:

Time of Funeral Services: Please do not set the time of funeral service without first confirming with our office.

Cemetery: It is advisable to complete Mortuary arrangements, including the casket selection,before making cemetery arrangements. The cemetery may have certain requirements that must be finalized at the Mortuary first.

Clothing – Ladies: May be purchased a time of arrangements or following items should be brought to the Mortuary at time of arrangement: underwear, stockings, slip, and dress or other suitable garments, and eyeglasses, if worn. If a recent picture is available, we suggest it be brought in also.

Clothing – Men: May be purchased a time of arrangements or following items should be brought to the Mortuary at time of arrangement: underwear, socks, suit, shirt, and tie, or other suitable garments, and eyeglasses, if worn. If a recent picture is available, we suggest it be brought in also.

Clergy: If you do not have your own clergyman, we will aid you in your selection.

Funeral Notices:Funeral Notices are inserted in the local papers by the Mortuary at the family’s request. We will assist you with the proper composition and format required.

Flowers: If flowers are desired we will consult with you as to the type or arrangement needed.

Insurance: When some forms of insurance are involved, special precautions must be taken to make certain that information you give us will compare favorably with the insurance record. We will aid the family or insurance agent in assembling the data necessary for prompt settlement of claim.

Veterans: Bring discharge or copy of discharge to Mortuary at time of making arrangements.

Shipment of Remains: If remains are to be forwarded to another city, we generally are able to promptly secure air or ground reservations. You will be required to inform us the name of the receiving funeral director.

Please feel free to call us with any questions regarding the above instructions. We will do our best to help.
Thank you.