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Ver 2.10

Pre-Arrangements

Pre-arrangements - Form

You may fill out this form and submit it online or print it using your browser print button and mail it to:

Dobratz - Hantge Funeral Chapel
 899 Highway 15 South
Hutchinson, MN 55350

Vital Statistics and Data

Full Name
Social Security Number
Permanent Address:
Address Line 1
Address Line 2
City
State
Zip
Telephone Number
Birthdate
Birthplace
Occupation (or retired from)
Employer (most recent)
Retirement Date
Sex:
Male Female
Marital Status:
Single Married
Widowed Divorced
Spouse (use wife's maiden name)
Marriage Date and Place
Father's Name
Mother's Name (maiden name)
Religious Affiliation/Church Membership
Education (highest level completed)

Funeral Service Requests

Funeral Home/Funeral Director
Telephone Number
Funeral Ceremony To Be Held At:
Church Funeral Home
Other 
Type of Ceremony Traditional Memorial Graveside Only
Clergy/Officiant
Readings/Scripture
Music Selections/Musicians
Casket Bearers:
1)  4) 
2)  5) 
3)  6) 
Alternates:   
My Clothing Preference
Jewelry
Remove jewelry     Leave jewelry on
Eye Glasses: Yes    No

I prefer the following Method for Disposition of My Remains:
Earth Burial Entombment Cremation
My Casket Preference:
Hardwood Protective Metal Nonprotective Metal Family Choice
Outer Burial Container (Usually a Cemetery Regulation)
Sealed Vault Concrete Grave Box Family Choice

If Cremation - Disposition of Cremated Remains:

Burial

 Scatter Columbarium Niche
- My Urn Preference:
Hardwood Metal Family Choice

A note to my family and friends - You will be the ones who make the final decisions regarding my funeral arrangements.  These requests are intended to be a guideline when the time has come for you to make these decisions.

Cemetery Information

Cemetery
City
State
Grave Number Lot Section Block
Cemetery Deed in Name of
I have not selected a gravesite, but would prefer burial to take place at the following cemetery:
Monument/Grave Marker Preference
Additional Information

 

Veterans Information

Veteran: Yes    No  
Branch
War Service
Rank
Date Enlisted
Place Enlisted
Date Discharged
Place Discharged
Branch of Service
Service Number
Claim Number
Location of Discharge Papers
Additional Information and/or Requests for Military Rites and Honors

 

Obituary Information
(Please include dates and places if known)

Baptism
Confirmation
Education
Marriage
Residences
Occupation/Employment
Service Organizations
Hobbies/Retirement Activities
Announce on Radio station
Publish in Newspapers

 

Survivor Information
(Please use full name, city and telephone number)

Email address (required)
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