Lafferty and Smith Colonial Chapel

Pre-Need

Having served generations of families during the years we’ve been in business, we realize how difficult it is for people after the loss of a loved one. We understand that planning a funeral involves making difficult decisions at a very emotional and highly charged time. We also understand that a funeral service doesn’t have to cost a fortune. We know the value people place on family and the value of a dollar.

As a vital part of our unwavering commitment to excellence in service, we’re always searching for ways to greatly reduce this emotional and often-times financial burden that accompanies the loss of a close loved one. Funeral Prearrangement meets this need.

Our staff of trained, certified, Funeral Prearrangement Professionals are specialists in their field. They can provide the insight, experience and professional counseling you deserve, free of charge or obligation.

Think carefully about what will be best for you and your family. Fully discuss why you desire certain arrangements and accompanying merchandise. By arranging today, you are assured peace of mind for you and your loved ones before the time of need.

If you are interested in prearranging your service, take some time to fill out as much information as possible and submit this form to us electronically by clicking on the "submit" button.

Your Full Name:

Your Email Address:

Your Maiden Name:

Street/Mailing Address:

City:

State:

Date of Birth:

Place of Birth:

Social Security Number:

Spouse's Name (including maiden name):

Spouse Survived?
Yes No

Marital Status:

Date of Marriage:

Place of Marriage:

Names of Previous Spouses:

Name of Mother and her place of birth:

Name of Father and his place of birth:

Address of Parents (if still living):

Names of Children:

Addresses and Phone numbers of Children:

Names of Brothers and Sisters:

Addresses and Phone numbers of Brothers and Sisters:

Names of other friends and relatives who should be notified:

Addresses and Phone numbers of other friends and relatives:

Occupation, including type of business and # of years in occupation:

Names of present employer(s):

Addresses and Phone numbers of present employer(s):

If you are a veteran

Date of enlistment:

Place of enlistment:

Date of discharge:

Place of discharge:

Rank:

Service Numbers:

Organization or outfit:

Commendations received:

Location of discharge papers:

Flag desired to drape casket:

Religious affiliation:

Professional and fraternal organization memberships:

Education (list schools attended and dates of any degrees or honors received):

Names of newspapers for obituary:

Organ Donation (list of authorized card and anyone who should be notified):

Funeral director or funeral home you prefer:

Clergyperson or anyone else you would like to officiate:

Funeral Service Location:

Visitation instructions:

Music, hymns or readings you would prefer during your service:

Memorial Donations you would like in your memory:

Cemetery Name:

Address and location of cemetery property (include lot and grave number):

Casket and/or vault preference:

If you wish to be cremated, include disposition preference:

Any additional instructions:

Lafferty and Smith Colonial Chapel
4321 Sonoma Highway
Santa Rosa, CA 95409
707-539-2921
FD-356