Pre-Arrangements Form | Wasko Funeral Home and Kubina-Yuhasz-Wasko Funeral Home

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Kubina-Yuhasz-Wasko Funeral Home

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Home
Obituaries
About Us
Locations
- Campbell
- Boardman
Pre-Plan
- Pre-Arrangements
- Pre-Arrangements Form
Services
Veterans
Resources
At Need Form

Use this form to provide us with as much or as little detail as you wish. At a minimum, provide us with your name and telephone number and tell us how you'd like us to work with you on the remaining information using the options at the base of the form.

Select a Location:

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Wasko Funeral Home

Pre-Arrangements Form - Wasko

Personal Information

Full Name

Street

City

State/Province

ZIP/Postcode

Telephone

Date of Birth

SSN #

Email Address

Place of Birth

Mother's Name

Mother's Maiden Name

Father's Name

Marital Status

Never MarriedMarriedSeparatedDivorcedWidowed

Spouse's Name

Place of Marriage

Spouse's Maiden Name

Date of Marriage

Additional Family Members Please use the area above to enter the names of siblings, children and grandchildren. ie: John Doe- son

Work/Education History

Education Level

Grade SchoolHigh SchoolAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate

Occupation

Company Name

Length of Employment

Military Record

Did you service in the military?

YesNo

Do you have a copy of your discharge paperwork (DD214)?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Wars Fought in (if applicable)

Funeral Service Preferences

What Best Describes Your Funeral Wishes?

Do you want calling hours?

YesNo

If yes, where?

Place of Worship

Do You Own Cemetery Property?

YesNo

Do you want a funeral service?

YesNo

If yes, where?

Religious Denomination

If Yes, Which Cemetery?

Other Obituary Information

Lodge/Union/Clubs/Associations Involved In (please list all that are applicable)

Personal Hobbies/Interests/Other Information Desired For example: favorite sports teams, spending time with family, etc.

Next of Kin

Name of Person Who Will Handle My Arrangements

Address

Relation

SpouseChildParentSiblingOther

Phone Number

I have made a last will and testament

YesNo

Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed just keep my request and information on file

Anti-Spam Security Question

New Section - add your content below

Kubina-Yuhasz-Wasko Funeral Home

Pre-Arrangements Form - Kubina-Yuhasz-Wasko

Personal Information

Full Name

Street

City

State/Province

ZIP/Postcode

Telephone

Date of Birth

SSN #

Email Address

Place of Birth

Mother's Name

Mother's Maiden Name

Father's Name

Marital Status

Never MarriedMarriedSeparatedDivorcedWidowed

Spouse's Name

Place of Marriage

Spouse's Maiden Name

Date of Marriage

Additional Family Members Please use the area above to enter the names of siblings, children and grandchildren. ie: John Doe- son

Work/Education History

Education Level

Grade SchoolHigh SchoolAssociate's DegreeBachelor's DegreeMaster's DegreeDoctorate

Occupation

Company Name

Length of Employment

Military Record

Did you service in the military?

YesNo

Do you have a copy of your discharge paperwork (DD214)?

YesNo

Branch of Service

Date Entered Service

Date Discharged

Serial Number

Rank at Discharge

Wars Fought in (if applicable)

Funeral Service Preferences

What Best Describes Your Funeral Wishes?

Do you want calling hours?

YesNo

If yes, where?

Place of Worship

Do You Own Cemetery Property?

YesNo

Do you want a funeral service?

YesNo

If yes, where?

Religious Denomination

If Yes, Which Cemetery?

Other Obituary Information

Lodge/Union/Clubs/Associations Involved In (please list all that are applicable)

Personal Hobbies/Interests/Other Information Desired For example: favorite sports teams, spending time with family, etc.

Next of Kin

Name of Person Who Will Handle My Arrangements

Address

Relation

SpouseChildParentSiblingOther

Phone Number

I have made a last will and testament

YesNo

Summary Details

Additional instructions for us

Memorial requests or donations to charity

Please select from one of the options below:

Send me information about pre-arrangements

Contact me to set up an appointment

No appointment needed just keep my request and information on file

Anti-Spam Security Question

Wasko Funeral Home • Kubina-Yuhasz-Wasko Funeral Home

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