Girrbach Funeral Home

Girrbach Funeral Home has various pre-arrangement options. For specific details on those options, please contact the funeral home.
More and more people are choosing to preplan their funeral arrangements. Key benefits for preplanning:

Relieves stress on loved ones
Individual wishes can be made known to family members
Preliminary steps can be taken to qualify for Medicaid services

Pre-payment of funeral expenses is encouraged, but not a requirement. The key benefit for pre-payment of funeral arrangements:

Guarantees the funeral cost at today's current prices

Personal Information	* = Required Information
Last Name:*
First Name:*
Middle Name:
E-Mail:*
Address:*
City:*
County:
State:*
Zip Code:*
Phone #:*	ex: xxx-xxx-xxxx
Origin of Decent:	(English, German)
Next of Kin:
Next of Kin Phone:

Vital Statistics
Date of Birth:
Place of Birth:	City, ST
Marital Status:
Spouse's Name:
Spouse's Maiden Name:
Date of Marriage:
Father's Name:
Mother's Name:
Mother's Maiden Name:

Work/Education
Education (K - 12):
College (0-5+):
Occupation:
Business:
Company:

Military Record
Branch of Service:
Serial #:
Date Enlisted:
Date Discharged:
Rank at Discharge:
Discharge on file at:
Copy of Discharge Papers:	Yes No
Name of Wars:

Funeral Service Info
Place of Service:
Name:
Address:
City, ST Zip:	,
Phone #:	ex: xxx-xxx-xxxx
Place of Visitation:
Religious Denomination:
Place of Worship:
Lodge/Union:


Special Instructions
Flower Preference:
Music:
Casket Bearers:
Jewelry:
Glasses:
Clothing:
Other:

Disposition Request
Final Disposition:
Cemetery:
Address:
City, ST Zip:	,
Phone #:	ex: xxx-xxx-xxxx
Section:
Location:
Other Instructions:
I have made a last will and testament:	Yes No

Memorials & Donations
Please list any Memorials or Donations to Charity that you would like:

Obituary Information
Employment Information: Please include dates or number or years worked and employer names.
Preceeded in Death by:
Survived by: Please include the names and cities survivors reside in.
Organizations:
Hobbies:

Number of Death Certificates Needed:

Options
Please Select One:*	Send information about my pre-arrangement Contact me to set an appointment Please keep my information on file