Newton-Bracewell Chico Funeral Home, Funeral Services, Caskets, Urns, Cremation, Memorial Mausoleum

Planning Guide Form

We feel one of the most caring things anyone can do for their family is to prepare and plan in advance. We understand the need and sensitivity of planning one's arrangements. Planning eliminates the uncertainty and confusion about one's wishes.

Please fill in the following spaces below and we will keep all your information on file and send you an I.D. card for your wallet. If you would like further help with this matter or more information you can call us at (530) 342-9003.

Vital Information
Please Complete Only Those Options That Apply
NOTE: This information is needed for the death certificate only.
For more information on how this information will be used, please view our privacy policy.

TIP: Press the TAB key to move to each form field

Your Full Name

First	Middle	Last

Your E-mail:

Date of Birth:

Place of Birth:

Years lived in county:

Address:

City:

State:

Zip:

County:

Phone:

Fax:

Marital Status:

Social Security #:

Date of Marriage:

Place of Marriage:

Spouse's Full Name

First	Middle	Last

-
Spouse's Maiden Name:

Father's Full Name

First	Middle	Last

-
Father's Place of Birth:

Mother's Full Name

First	Middle		Current Last

-
Mother's Place of Birth:		Mother's Maiden Name:

**Work/Education History**
Grade School Level Completed (0-12):		College Level Completed:
Occupation:
Type of Business:

**Military Record**
Branch of Service:		Serial Number:
Date Enlisted:		Rank At Discharge:
Date Discharged:		Discharge On File At:
Copy of Discharge Papers: Yes No
Name Of Wars:
Person in Charge:
Address:
Phone:

**Funeral Service Request**
Place Of Service:
Name of Place:
Address:		Phone:
Place of Visitation:
Religious Denomination:
Place Of Worship:
Lodge / Union:
Person in Charge of Final Arrangements:

**Special Instructions**
Flower Preference:
Music:
Pallbearers (6):
Jewelry:
Glasses:
Clothing:
Other:

**Disposition Request**
I Prefer:
Cemetery:
Address:		Phone:
Section:
Power of Attorney for Health Care? Yes No I have made a last will and testament: Yes No
Will Location:

**Other Instructions**
Life Insurance Policies: 1. 2. Newspapers/Media:

**Memorials/Donations To Charity**

**Please select one of the options below**
Send information about pre-arrangement Contact me to set an appointment Please keep my information on file

PRIVACY POLICY

Newton Bracewell Funeral Homes are committed to respecting the privacy of our website visitors. Any data which you provide us is not shared with third parties unless required by law. Personally identifiable information will not be sold, rented, or exchanged with any other organization or entity unless you are first notified and expressly agree to it.

This website contains links to other websites. We will not be responsible for the accuracy or reliability of any information, advice, data, opinions, or statements found on these websites.

Any changes to these policies will be posted on this page.

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