ONLINE PRE-PLANNING FORM BELOW

Your family may not have to face funeral cost for many years. But by pre-arranging your funeral, you are helping to ease the burdens and emotional stress that your family could incur. By pre-arranging and / or pre-paying for you funeral, you are making your wishes known and allowing your family to grieve without the added burdens of having to make final decisions at an emotional time.

This form below is provided as a service to allow you to record funeral preferences for yourself or a loved one. Once you have filled in the information you may: (a) submit the form at the end, (b) print the completed form and mail it to Stokes-Southerland Funeral Home to keep on file, (c) or you may place it with your important papers.

PERSONAL DATA

Your Name (REQUIRED)

Address:

City

State

County

Zip

Phone

E-Mail

SSN

DOB

Father

Mother

Marital Status

Mother's Maiden Name

Date of Marriage

Spouse's Name

Spouse's Maiden Name

Place of Marriage

Branch of Service

Discharge Date

Enlisted Date

Church Member

Rank at Discharge

Employer

Occupation

I Hereby Request The Following

Services Held At

Preferred Clergy

Music

Funeral Director

Musician

Florist

Employer

Preferred Clothing

Pallbearers

I request

Location

Executor

Special Instruction

About Us

Locally owned and operated, Stokes-Southerland Funeral Home, has been "A Tradition of Trust" to Eastman, Dodge County and Middle Georgia for over 65 years.

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