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Tulsa area: (918) 291-1704
OKC area: (405) 531-0947

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Preplanning Online Arrangement Form

Please complete the form below and we will save the information in our private and confidential records.

I am arranging for*
Contact Person / Next Of Kin
Name*
First Last
Middle Name
Address*
Street Address City State ZIP Code
Email
Phone*
Cell Phone
Work Phone
Information of Person Arrangements are for
Name*
First Last
Middle Name
Address*
Street Address City State ZIP Code
Sex*
Date of Birth*
Age
Current location address and name of facility if applicable
Birthplace: City, State, Country*
Marital Status*
Name of Spouse (maiden name, if wife)
In Armed Forces*
Branch of Service
Race
- White
- Black or African American
- American Indian Or Alaska Native (name of enrolled or principal tribe)
- Asian Indian
- Chinese
- Filipino
- Japanese
- Korean
- Vietnamese
- Other Asian (Specify)
- Pacific Islander (Specify)
Other Asian (Specify)
Pacific Islander (Specify)
Social Security Number*
Usual Occupation (If retired, occupation previous to retirement)*
Kind of Business/Industry*
Education (highest completed) Elementary & Primary (0-12)*
Higher Education*
Father
Father's Name*
First Last

Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Middle Name
Step-Father Name
Mother
Mother's Name*
First Last

Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Middle Name
Maiden (last) Name*
Legal forms require this information. If you do not have this information, 'Unknown' will need to be inserted.
Step Mother Name
Cemetery Information
Burial/Cremation/Anatomical Study*
Cemetery Name
Location City/Location State of Cemetery
Church Information
Church Name
Denomination
Church Address
Street Address City State ZIP Code
Church Phone
Minister's Name
First Last
Minister's Phone
Family Information
Children (oldest to youngest with spouse info)
First (Spouse) Last
Grandchildren (oldest to youngest with spouse info)
First (Spouse) Last
Great Grandchildren (oldest to youngest with spouse info)
First (Spouse) Last
Siblings (oldest to youngest with spouse info)
If siblings are deceased, please type "deceased" before the respected name.
First (Spouse) Last
Membership in Organizations, Clubs or Societies
Organizations, Clubs, Societies: Name & Contact Information
Use separate line for each entry.
People / Groups to Notify about Funeral Services
Name of Person / Group & Email Address
Use separate line for each entry.
Post Title
Post Body
Phone
This field is for validation purposes and should be left unchanged.

Local Area Weather

Tulsa, Oklahoma

October 17, 2018, 6:39 am

Clear
39°F

sunrise: 7:32 am

sunset: 6:45 pm

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Phone: (918) 291-1704 · Email: info@greencountrycremation.com
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