Biography Submission Form

Your Name

First NameLast Name

Your Relationship

Your Daytime Phone:

Area CodePhone Number

Your E-Mail Address

Your Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

PREFERRED LOCATION FOR ARRANGEMENTS:______

Preferred Location

McCombs, Jackson, MOMcCombs, Cape Girardeau, MO

HISTORICAL RECORD OF:_______________________

First Name

Middle Initial

Last Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date

Age

Birthplace City

Birthplace County

Social Security Number

Occupation (Previous if Retired)

Education Info: Highest Grade Completed

8th Grade Or Less9-12 grade, no diplomaHigh School Graduate or GED CompletedSome College Credit But No DegreeAssociates Degree (i.e. AA, AS)Bachelor's Degree (i.e. BA, BS)Master's Degree (i.e. MA, MS, MBA)Doctorate (i.e. PhD, EdD)Professional Degree: (i.e. MD, DDS, DVM, JD)

Usual Occupation During Career Years

Type of Industry Worked In During Career Years (i.e. Education, Manufacturing, Retail, Self Employed

Job Title: i.e. Nurse, Teacher, Sales Clerk, Mechanic)

Marital Status

Spouse Name

Spouse's Maiden Name If Female

If Deceased, Spouse's Date of Death

Date of Marriage

Name of Father

Mother's Name

Mother's Maiden Name

VETERAN INFORMATION________________________

Name of War

Service Number

Branch of Service

If OTHER, please explain:

Place Inducted

Induction Date

Place Discharged

Discharge Date

Discharge Papers Located

Rank/Rate when Discharged

Type Of Discharge

HonorableMedicalDishonorableOther Than Honorable

Flag to Drape Casket?

YesNo

Please attach copy of DD214 form if available

Upload a File

CHILDREN____________________________________________

Child 1, Name, Address, Phone

Child 2, Name, Address, Phone

Child 3, Name, Address, Phone

Child 4, Name, Address, Phone

Child 5, Name, Address, Phone

Child 6, Name, Address, Phone

Child 7, Name, Address, Phone

Other Survivors, Name, Address, Phone:

BROTHERS AND SISTERS____________________________________________

Name, Address, Relationship

Additional Brothers and Sisters, Name, Address, Relationship

PERSONAL WISHES AND DESIRES_______________________________

This is information families never discuss - especially the children. but yet, if something had happened to you last night, these are the questions your funeral director would be asking your family today.

I Prefer My Funeral/Memorial Service:

At the funeral homeAt the churchOther

If 'Other' Please describe

Preferred Method Of Disposition

Viewing and Traditional Funeral Followed By EARTH BURIALViewing and Traditional Funeral Followed By CREMATIONCremation Followed By Memorial ServiceCremation only

Preferred Newspaper(s) for obituary

Southeast MissourianCash Book JournalNo ObituaryOther

If 'Other' Please describe

Name Of Church

Favorite Minister/Priest

Favorite reading/scripture(s)

Favorite Songs/Hymns

I Prefer

Memorial Contributions Instead Of FlowersFlowers OnlyBoth Memorial Contributions and Flowers

Preceded In Death By:_____________________________

Spouse, Children, Grandchildren, Siblings, Parents

Additional Information:_____________________________

Direct Any Memorial Contributions to:

What Clothing Do You Prefer?

Would you like to wear Jewelry?

YesNo

Jewelry To Be Removed?

YesNo

Would You Like To Wear Your Eyeglasses?

YesNo

Do You Have Cemetery Property?

YesNo

Name/Location of Cemetery Property (Lot #, Space #)

Active Pallbearers - List Names and Phone Numbers, 6 total

Honorary Pallbearers - List Names and Phone Numbers, 6 total

Additional Biographical Information (i.e. Church Memeberships, Clubs, Organizations, Work History, Hobbies)

For the purposes of relieving my family in the event of need, the preceding arrangements are my personal wishes and desires.

E-Signature: Type Full Name

Help us battle spam by typing this text in the box below*

McCombs Funeral Home, Inc. - Biography Submission Form