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Arrangement Form

Fields in red are required.

Sender's Information:
Name (first, middle, last)
Address
(address, city, state, zip)
Daytime Phone (include area code)
Evening Phone
Email
Please choose one of the following:
At-Need Arrangements
Pre-Need Arrangements

Arrangements For:
Name (first, middle, last)
Maiden Name (If there is no Maiden Name, list "None")
Social Security # (optional)
Sex (Male or Female)
Residence
State
County
Address
City/Township/Village
Please include a complete address; as well as physical location of residence (City, Township, or Village) rather than mailing address if they differ.
Birth
Date (mm/dd/yyy)
State
City/Township/Village
Parents' Names
Father (first, middle, last)
Mother (first, middle, maiden name)
Race
If Hispanic, please include origin (Mexican, Cuban, Spanish, Etc).
If Native American, Please Include Tribe.
Highest Education Completed
Grade 1-12
Yrs. of College
Occupational Title
This category is the occupation or job one has engaged in for most of his or her working life; the greatest amount of working years. Please be specific, as the state of WI does not accept generalizations such as Laborer or Retired.
Type of Industry
Specifying the name of the company is not sufficient unless the name describes the nature of the business.
Marital Status (Married, Never Married, Widowed, or Divorced)
Spouse's Name
(first, middle, last,
& maiden name)
(If there is no Maiden Name, list "None")
Military
* If the military status is veteran, a copy of the discharge papers (DD214) needs to be emailed, faxed, or mailed to the funeral home.
Please be aware that a copy of the discharge papers (DD214) might be available through your local Veterans Service Office and any benefits may be applied for through the local or state office. If there is no Military History, list "None".
Veteran, Reserve, Retired, or Active
Branch of Service
Informant's Information
The Informant is the person supplying or verifying the necessary vital statistic information required by the State of WI and authorizes funeralization and final disposition. Only the next of kin may authorize funeralization and disposition at the time of death. Please be aware that power of attorney over another ends at death and possesses no continuing authority. If there is no next of kin, authority may be directed to an individual with tangible interest.
Name (First, Middle, & Last)
Social Security # (optional)
Address
Daytime Phone (include area code)
Evening Phone
Cell Phone
Email Address

Funeralization:
A Funeral is any public service, ceremony, ritual, rite, observance, sacrament, celebration, gathering or custom relating to death and grief. There are two types of Funerals: a Funeral Service & a Memorial Service. A Funeral Service is a funeral with the human remains present for the service. A Memorial Service is a funeral without the human remains present for the service. Please note that a Funeral and the Disposition of Human Remains are independent categories. One may choose to have a Funeral Service (a service with the body present) and choose any type of disposition (burial, cremation, entombment, or donation to science) to follow. A Memorial Service may also be chosen with the same options of disposition. Visitations are gatherings that allow for cherishing and sharing memories and sentiments. Visitations usually do not incorporate any formal ceremonial practices, although one may do so if desired. One may also choose to have the body present for visitation. This is a common practice. Embalming is required for all public viewings or a funeral service (with the body present).

Please check only one category: Funeral Service or Memorial Service. Then continue to the Visitation information. If you have not chosen particular location at this time, please indicate "Pending" within the location box.

Funeral Service (A funeral with the human remains present):
We are always willing to help arrange a particular location for a Funeral Service and Visitation. Please note that we will help secure authorization to use the requested accommodations at the time of need. We are proud to offer our Services at any given location. The use of our funeral home and facilities are always welcomed.
Funeral Service
Location of Service
Address
Phone (include area code)
Officiant/Celebrant
Memorial Service (A funeral without the human remains present):
We are always willing to help arrange a particular location for a Memorial Service and Visitation. Please note that we will help secure authorization to use the requested accommodations at the time of need. We are proud to offer our Services at any given ocation. The use of our funeral home and facilities are always welcomed.
Memorial Service
Location of Service
Address
Phone (include area code)
Officiant/Celebrant
Please note that we will contact the Officiant/Celebrant listed above to arrange a funeral. Due to the unpredictability of life's end, the Officiant/Celebrant listed above may not be available for a particular time or date. We will do our best to mediate a time and date on your behalf with the selected or an alternative Officiant/Celebrant. If you are uncertain of an Officiant or Celebrant choice, we would be honored to recommend, locate, or provide a religious minister or a nonreligious celebrant in your time of need.

Visitation (A time of Sharing Memories and Celebrating Life):
Location of Visitation
Address
Phone (include area code)
Contact Info
Addition Information or Disclosures

Disposition of Human Remains:
Please check only one category: Burial/Entombment, Cremation, or Donation to Science. If you have not chosen particular location at this time, please indicate "Pending" within the location boxes.
Burial or Entombment
Cemetery Name
State
County
City/Township/Village
Address
Grave/Tomb Location
(Section, Block, Lot, Space)

Cremation
Will the body be present for the funeral service or visitation?
Yes or No
Disposition of Cremains (Please Select one of the following if Cremation is requested):
Burial of Cremains
Urn Niche
Scattering of Cremains
Family will Maintain Cremains
For Burial or Urn Niche
Cemetery Name
State
County
City/Township/Village
Address
Space/Niche Location
(Section, Block, Lot, Space)

Donation to Science
Please note; a funeral service (service with the body present) may be possible if requested before donation. Fill out the funeral service portion listed above and notify the donation entity of the request. All Donation to Science arrangements must be made to with that specific entity.
Entity/School
Location
State
County
Address
Phone (include area code)
Email Address

Obituary Information:
Surviving Family Information
Children


Grandchildren


Siblings


Parents


Others

Obituary:
Preceded in Death

Please list all family members that precede in death and how they are related.

Memorial

One may choose to list a charitable organization, trust fund, church, society, club, & etc in which others can donate to.

Personal Information
Please include Life History: Location of Birth; Location or Area in which one Grew Up; Educational History; Marriage Location (state, city, court, church, or location); Occupations & Employers; Hobbies; Interests; Military Information; Clubs; Elected positions; and Any Other Information you may wish to disclose:

Rembs Funeral Homes
300 S. Oak Ave. - Marshfield, WI 54449
Toll Free: 888-736-2705     Fax: 715-384-2160     E-Mail: mail@rembsfh.com