Ruebel Funeral Home

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Arrangement Form

Thanks for taking the time to fill out the At Need Planning Form. By completing the following information at your own convenience, you should find it easier to provide correct information and have some time to think about the type of services you desire.

The information provided on this form will help the funeral home complete the death certificate and other required documents. In addition, this information will assist the funeral director to better understand your initial wishes. Relaying required statistical information can be time consuming. Our desire is to help expedite the final arrangement conference at the funeral home and make the process a little more comfortable.

Please complete (as much as possible) the information on the form and select Submit Information at the end to email to the funeral home. You may also print out the form and bring it with you to the arrangement conference or fax.

If you have any questions, please contact the funeral home at any time. Thanks again for helping us serve you more efficiently.

Deceased Statistical Information

Last Name:
First Name:
Middle Name/Initial:
Sex:		If Female, Give Maiden Name:
Race:

Date of Birth:	//
Place of Birth:	City:
	State:
	Country:

Date of Death:	//
Place of Death:	City:
	State:
	County:
	Country:

Location of Death:
	If Other Place, Please list address. If hospital or nursing home, Please list name and location.


Social Security Number:	--
Education:	Primary:
	Secondary:
Usual Occupation:			Please do not put "Retired" - list occupation for most of life.
Kind of Business:
Company Name:	(Optional)
Marital Status:
Surviving Spouse:
If wife, give Maiden Name:

Residence:	Street:
	City/Town:
	Inside City Limits?
	County:
	State:		Zip Code:
Length of Residence:

Father's Full Name:
Mother's Full Maiden Name:

Type of Disposition

Disposition will be:
If Cremation, disposition of Ashes:
If "Other", Please Specify:
Name of Cemetery (if applicable):
	City:
	State:

Preparation and Viewing

Important Note: Viewing of the body is a choice of the family. In most cases, embalming is required or recommended for public viewing/visitation, mausoleum entombment, or transfer of remains via common carrier (i.e. shipment by air or rail). When possible, the funeral home needs authorization from the next of kin for embalming.

Except in certain cases, embalming is not required by law. Embalming may be necessary, however, if you select certain funeral arrangements, such as a funeral with viewing. If you do not want embalming, you usually have the right to choose an arrangement, which does not require you to pay for it, such as a direct cremation, immediate burial and/or one-time ID viewing for family only. If you elect NOT to order embalming, State of Arkansas law requires refrigeration of an unembalmed body that is held for over 24 hours from the time of death.

The Family Preference regarding viewing/embalming is:
I Authorize Ruebel Funeral Home to embalm:
Name of authorizing Person:
Relationship to deceased:

Veteran Information

Was Decedent ever in U.S. Armed Forces:	(If no, please continue to next section)
Branch of Service:
Date Enlisted:	//
Date Discharged:	//
Honorable Discharge:
Military Serial Number:
Is Copy of Discharge Papers available?	(This form is Form DD214 - If yes, please bring for us to copy)

Informant Information

Name of Person In Charge:
Relationship to deceased:
Address:	Street:
	City:
	State:	Zip:
Phone Number:	Primary:	()-
	Secondary:	()-
Email:

Funeral / Memorial Service Info

Preferred Place of Service:
Religious Denomination (Optional):
Minister's Name (if available):

Pre-Arrangement Information

Is there Pre-Need or Burial Insurance on the decedent?
If yes, who is it with?

Special Instructions

If there are any special needs or instructions, please indicate them below.

Please remember to call the funeral home to set-up an appointment. You may come to the funeral home, or we will be happy to come to your residence to finalize the arrangements.

If you are finished with the form, please click "Check details" below to proceed.