Kingston Funeral Home
326 Albany Avenue
Kingston, New York 12401
Port Ewen Funeral Home
216 Broadway
Port Ewen, New York 12466
Kingston Funeral Home
65 Lucus Avenue
Kingston, New York 12401
Keyser Funeral & Cremation Service, Inc. (845) 331-1473 | A. Carr & Son Funeral Home (845) 331-0625

Secure Preneed Planning Form

Fill out and submit the secure Pre Planning form below to begin the Pre Planning process

Personal Information
Name (First Middle Last):    
Marital Status:    
Date of Birth:    
Place Of Birth:    
Address:
City: State:
County: Zip:
Phone: E-mail:
Spouse's Name: Spouse's Maiden Name:
Place of Marriage: Date of Marriage:
Father's Name: Mother's Name:
Mother's Maiden Name:    
Informant:    
Address:    
Phone:    
Work/Education History
Education (0-12): College 1-5+:
Occupation:
Business: Company:
Military Record
Branch of Service: Serial Number:
Date Enlisted: Rank At Discharge:
Date Discharged: Discharge On File At:
Participated in Wars
Funeral Service Request
Place Of Service:    
Funeral Home:
Address:
Phone:    
Place of Visitation:
Religious Denomination:
Place Of Worship:
Newspaper Information
 

Please list family members

  
Children:
Brothers/Sisters:
Number of Grandchildren:    
List any other significant relatives:
Special Instructions
Organizations: 1.
2.
3.
Jewelry/Glasses
Do you have an existing Pre-Arrangement with another funeral home?
Person in Charge of Arrangements:
Other Instructions
 
Memorials/Donations To Charity
 
Keyser Funeral & Cremation Service, Inc.
326 Albany Avenue - Kingston, New York 12401
216 Broadway - Port Ewen, New York 12466
Phone: (845) 331-1473
A. Carr & Son Funeral Home
65 Lucus Avenue - Kingston, New York 12401
Phone: (845) 331-0625

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