Planning Ahead

Online Preplanning Form

The staff of Pellerin Funeral Home has the experience and knowledge to assist you with your pre-planning needs. Call us to setup an appointment or utilize our online Secure Preplanning Form.

If you have any questions, or would like assistance with this form, please call (337) 365-3331 or (337) 332-2111

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Name of Person Completing Form

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Phone Number

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Information about whom this plan is for

Email Address

Last Name*

First Name*

Middle (Maiden) Name*

Sex*

Race*

Marital Status*

Surviving Spouse (Maiden Name)

Date of Birth*

Birthplace*

Occupation*

Industry*

Ever in Armed Forces?*

Education (Highest Level)*

Street Address*

Parish of Residence*

State of Residence*

City, Town, or Location

Zip Code*

Residence in City Limits (yes/No)*

Father's Name*

Father's Birthplace, City & State*

Mother's Maiden Name*

Mother's Birthplace, City & State*

Veteran Service No./Serial No

Branch of Service

War Served

Type of Discharge

Flag on casket (Yes/No)

Military Detail (Yes/No)

Place of Service

Cemetery

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Surviving Relatives and City of Residence

Father

City of Residence

Brothers/Sisters and Spouses (include "," after each sibling and spouse)

Mother

City of Residence

Children & Spouses (include "," after Children)

Spouse

City of Residence

Grandchildren, Great Grandchildren, Great Great Grandchildren (List each name or enter the number each below)

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Grandchildren

Great Grandchildren

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Great Great Grandchildren

Preceded in death by*

Organizations, Employment, Hobbies, Interests:

ITEMS TO BRING TO THE ARRANGEMENT CONFERENCE:

Photo for Newspaper, Web-Site, Prayer Cards, etc...
Clothing (long sleeves with collar) and undergarments
Life Insurance Policies • Rosary (optional)
20 unframed photographs (no larger than 8 x 10) for video tribute
Military Discharge papers (DD214)
Names of pallbearers, gift bearers, readers

WE WILL ASSIST YOU WITH THE FOLLOWING:

Obtaining Certified Death Certificates
Contacting Clergy and/ or Church
Preparing and sending obituary to the newspapers
Securing Flag for Veterans
Arranging for Military Honors
Processing Life Insurance Claims
Notifying the Social Security Administration of death

ITEMS NOT INCLUDED WITH A FUNERAL SERVICE

Newspaper Obituary Fees
Musicians
Cemetery work - Once arrangements have been completed, the family must contact the cemetery office in order to obtain a permit. There is normally a fee for this permit.
Flowers
Clothing
Clergy Honorarium