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Funeral Request Form
1. General Information
Name of deceased
Name of family member making decisions
Phone Number
Email
Name & Phone Number of Funeral Home (if applicable)
Date Requested for Service
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
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9
10
11
12
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16
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18
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25
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28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
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1945
1946
1947
1948
1949
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1951
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1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
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2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Time Requested for Service
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
Will there be a graveside service? If so, where and when will it be held?
Is a meal needed? If so, for how many?
What is the anticipated attendance for the funeral?
Officiants
Will a Heritage pastor be officiating? If so, who?
Marty Brown
Jonathan Dirrim
Jim Jackson
Chad Kositzky
Jeff Plangman
Will any other staff members be needed on the the platform? (Please list)
If a non-Heritage pastor is preferred, please provide their name and phone number
Phone Number
Musicians & Song Choice
Will people from Heritage be asked to help with the music? If so, who?
Will non-Heritage be asked to help with the music? If so, who?
What songs will be used? (Please provide list) (Any recorded music should be in mp3 format)
Audio/Visual Needs
Will there be a slideshow/video? (All videos need to be in mp4 format)
Yes
No
Do you want the service to be live-streamed?
Yes
No
Will there be an open-mic?
Yes
No
Programs
Will the funeral home provide the programs?
Yes
No
If you want Heritage to provide programs, please list the pertinent information to be included in the program (obituary, birthday/date of passing, Scripture verses, etc.)
Support Staff Needed
Please check the support staff you will need
Sound / Projection ($100)
Video / Livestream ($100)
Ushers
Meal Service (if applicable)
Logistics
Will there be a body at the service?
Yes
No
Will flowers be delivered outside of normal business hours (Mon-Thurs, 9-5)?
Yes
No
What time will the family be arriving at the Heritage facility?
How many family members will be in attendance (for seating purposes)?
Will any equipment be needed (easels, tables, etc.)?
Will there be military honors or any other unique elements?
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