Robert Massie Funeral Home

Wade Bailey

Toby Arredondo Jr.

Robert Massie Funeral Home
402 Rio Concho Drive
San Angelo, TX 76903
325-655-8121

Forms

These forms may be opened in MS Word.

Family Information Work Sheet

Family Obituary Template

Planning a Service for a Loved One

Items marked with an (*) are required for completion of the Death Certificate.

Deceased's Name as to appear in Obituary:
*Deceased's Name as appears on Social Security:
*Residence:
*City:
*State:
*Zip:
*Inside City Limits:
*Sex:
*Race:
*Of Hispanic Origin?:
*Of Hispanic Origin? Yes:
*Marital Status:
*City of Birth:
*State of Birth:
*Date of Birth:
*Age:
*Deceased's Fathers Name:
*Deceased's Mothers Name:
*Deceased's Mothers Maiden Name:
*Occupation (Retired not accepted):
*Industry/Employer:
*Social Security Number:
*Education (For Death Certificate Only):
*Spouse Name (If wife, First & Maiden):
Place of Marriage:
Date of Marriage:
Is Spouse Deceased:
Date of Spouse's Death:
*Deceased a Veteran:
Veteran Branch:
Veteran Rank:
Wars served:
Have a copy of DD-214 (Discharge):
Wish to have Military Sevice:
Preferred Service Information
Will this be a Burial or Cremation?:
Time:
Date:
Location of Service:
Minister:
Cemetery:
Already own spaces:
Space Owners Name:
Headstone already in place:
Set Family Visitation to receive friends:
Time: From (Time) To (Time):
Date:
Prayer or Rosary Service:
Time:
Date:
Pallbearers list in Obituary:
Pallbearers (6 Minium):
Songs (Artist if preferred) 2 to 3 songs:
Traditionally for services caskets are open before and after services for final viewing
Your Preference:
Family Contact Information
Main Contact Phone for Family:
Informant is the person mainly responsible.
Informant Name:
Informant Address:
Informant Relationship:
Informant Home Phone:
Informant Cell Phone:
Informant e-mail :
Preceded In Death By: (if wanted in paper):
Survivors (Relationship, Name, of location):
Helpful information for Obituary:
Memorials in lieu of flowers:
Memorials to::
HELPFUL HINTS OR ITEMS TO BRING:
Picture: For Obituary and/or Hairdresser
DD-214 ( Military Honorable Discharge Papers)
Clothing (Please include all under clothing necessary)
If desired: Glasses, Jewelry & etc (May be returned)
How many death certificates you may need us to order for you.:
Burial Insurance Policies that we may help you with.

For security, please enter the letter or number displayed in the corresponding box below each character. The letters do not have to be capitalized