Pre-Arrangement Form
This is a "smart" form that will adapt to many different situations. You may fill out the form for yourself, your spouse, your parent, another family member, or friend. You may include as much or as little detail as you wish. There are no required fields - feel free to leave any portion blank.

It takes approximately 30 minutes to complete this form for non-Veterans, and 40 minutes for Veterans. You may click "Save and Continue Later" to pause your progress and return to the form in the near future.

Your information will be kept on file. Your information is confidential and is never shared or distributed. If you would like a copy of your submission, please indicate so at the bottom of the form.

If you would like to Pre-Fund with a trust or insurance policy, please indicate this at the bottom of the form. Pre-Funding does require an appointment at the funeral chapel or in your home.
These plans are for my...*
About You
This section pertains to the person completing the form.
Name
First Middle Last
E-mail
Home Phone
Cell Phone
Address
Street Address City State ZIP Code
Do you receive mail in care of the person for whom you are Pre-Arranging?
- Yes
- No
Do you have Power of Attorney?
- Yes
- No
Please upload POA Form, if available.
Please upload POA Form, if available.
Drop files here or

Accepted file types: jpg, pdf, Max. file size: 5 MB.

Save and Continue Later

Vital Statistics
The following information will be required to complete the death certificate. It may be completed now or at the time of death.
Name
First Middle Last (Maiden)
Date of Birth
MM slash DD slash YYYY
Place of Birth
City State / Province / Region Country
Sex
- Male
- Female
Social Security Number
Our website uses encryption to securely transmit this information. However, you may phone us with this information if you prefer.
Race
Ethnicity
Marital Status
Spouse's Name
First Middle Last or Maiden
Spouse's Date of Birth
MM slash DD slash YYYY
Spouse's Date of Death
MM slash DD slash YYYY
Who handled Spouse's Funeral Services?
- Morris Nilsen Funeral Chapel
Father's Name
First Last
Mother's Name
First Maiden

Save and Continue Later

Living Situation
This section pertains to the person for whom the pre-arrangement is being made.
Current Residence
- Own Home
- With Person Completing Form
- Nursing Home or Assisted Living Facility
- Hospital or Hospice
Home Address
Street Address City State ZIP Code
Nursing Home or Assisted Living Facility
Facility Address City State ZIP Code
Hospital or Hospice
Facility Address City State ZIP Code
Facility Phone

Save and Continue Later

Funeral Service Information
Desired Funeral Services
To learn more about the types of Funeral Services available, visit Burial Services or Cremation Services. Links will open in new windows.
- Traditional Service
- Memorial Service
- Graveside Service
- No Funeral Service (Direct Burial or Cremation)
Service Location
Name Address City State ZIP Code
Desired Visitations
- Day before Service
- Day of Service / Immediately before Service
- No Visitation
- Private Family Viewing
Visitation Location
Name Address City State ZIP Code

Save and Continue Later

Final Disposition
Preferred Method of Final Disposition
- Burial (Casket)
- Cremation (Urn)
Cremated Remains should be...
- Buried
- Entombed in Niche
- Returned to Family
- Scattered
- Undecided
Cemetery
Name Address City State ZIP Code
Columbarium
Name Address City State ZIP Code
Burial Property Details
- Already Own Burial Property or Niche
- Marker Already in Place
Burial Property or Niche Location

Example: Section 18 - Lot 22 - Grave 9
Scattering Location
Casketbearers
List up to 6 names of desired casketbearers.

Save and Continue Later

Pre-Arrange Online

Pre-Arrangement Form