* Last Name
* First Name
Middle (Maiden) Name
* Your E-mail address
Sex	Male Female
Race
Marital Status	Single Married Divorced Widowed Other
Surviving Spouse
Date of Birth
Birthplace
Occupation/Industry
Ever in Armed Forces	Yes No
Education (Highest Level)
Street Address
City
Parish of Residence
State of Residence
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 #
Branch of Service
War(s) Served
Date Entered
Date Discharged
Type of Discharge
Flag on Casket	Yes No
Military Detail	Yes No
Church
City
Cemetery Location
Preferred Service Type	Burial Cremation
Father
Mother
Husband
Wife
Maternal Grandparents
Sons
Daughters
Brothers
Sisters
No. of Grandchildren
No. of Great Grandchildren
No. of Great Great Grandchildren
Preceded in Death by
Organizations
Special Instructions
I would like to Prefund (for Pre Need Only)	Yes No

Ask about our VA Benefit, Social Security Benefits, and Wayne County VA Fund.

Helpful guide to information you may need:
Advise a family member of the location of your life insurance policies.
Make sure that your beneficiary information is up to date.
If you are a veteran, your family will need a copy of your discharge papers to obtain a Flag, V.A. Memorial Plaque, and any benefits to a surviving spouse, if they should qualify.

We assist families in the following areas:
We will notify the Social Security Administration of death.
Process all of the life insurance claims.
Prepare and send obituaries to newspapers requested.
Take the Death Certificate to the attending physician for completion and file in the appropriate city or county.

These are items that are not included with funeral service:
Clothing
Flowers
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.
Clergy donation
Music
Certified Death Certificates
Newspaper Obituary Fees

Items to bring with you to funeral arrangements:
Life Insurance Policies
Clothing (long sleeves with collar) and undergarments
Rosary (optional)
Photo for Web-site, Obituary, Register Board and Prayer Cards

Should you have any questions, please do not hesitate to call Uht Funeral Home
at 734-721-8555.