Benson Funeral HomeSt. Cloud, MNLove Lasts Forever
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Planning
Please fill out the following form as completely as possible. You will receive a copy of the information to the email address you specify. A representative of Benson Funeral Home will contact you to discuss Pre-Planning.

* Indicates required fields.
    FORM COMPLETED BY
Name:   *
Email Address:   *
Phone:   *
     
    VITAL STATISTICS
First Name:
  
Middle Name:
  
Last Name:
  
Address:
  
State:
  
County:
  
City, Village or Township::
  
Inside Corporate Limits:
   Yes    No
     
Sex:   Male   Female
Hispanic Orgin:
   Yes    No
Age:
  
Date of Birth:
  
Race:
  
   
Birthplace:
   (state or foreign country)
Citizens of What Country:
 
   
Married, Never Married, Widowed, Divorced:
  
Spouse Name:
  
Mother - Maiden Name:
 
Father - Name:
  
   
Highest Level of Education Completed:
  
   
Veteran of U.S. Armed Forces:
   Yes    No
   
Social Security Number:
 
   
Occupation:
  
Business/Industry:  
     
Special Instructions/Requests  
     
Obituary to be placed in the following newspapers:  
     
Date and Place of Marriage(s):  
     
Church Member:  
     
List Education, Employment, Clubs, Noteworthy Achievements, Etc:  
     
Hobbies:  
     
    VETERAN INFORMATION
Branch of Service:  
Rank or Grade:  
Date of Entry:  
Place:  
Date of Separation:  
Place:  
Service Number:  
Claim Number:  
Do you still have G.I. Life Insurance:   Yes    No
G.I. Life Insurance Number:  
     
    VETERANS FUNERAL SERVICE OPTIONS
Flag Draped on Casket:   Yes    No
Flag Folded:   Yes    No
Military Marker for Cemetery:   Yes    No
     
    MILITARY HONORS AT CEMETERY
Rifle Squad (21-Gun Salute):   Yes    No
Color Guard:   Yes    No
Taps:   Yes    No
     
    SURVIVING RELATIVES
Father:   (list name, city and state)
Mother:   (list name, city and state)
Husband/Wife:   (list name, city and state)
Sons:   (list name, city and state)
Daughters:   (list name, city and state)
Brothers:   (list name, city and state)
Sisters:   (list name, city and state)
Grandchildren:   (list no. only)
Great Grandchildren:   (list no. only)
Great Great Grandchildren:   (list no. only)
     
Preceded in Death By:  
     
    SERVICE DETAILS
Place:  
Clergy:  
Music:  
Pallbearers:  
Honorary Pallbearers:  
Visitation Hours:  
Rosary/Wake Service:  
Prayer Service:  
In Lieu of Flowers:  
     
    FINAL DISPOSITION
    Burial   Entombment  Cremation
Cemetery:  
City:  
County:  
State:  
Grave No.:  
Lot:  
Section:  
Block:  
Lot Owner:  
If Cremation, Disposition of Ashes: