The Boldt Funeral Home    300 Prairie Avenue    Faribault, Minnesota   55021

(507) 334-4481  (800) 657-7095

www.boldtfuneralhome.com

scott@boldtfuneralhome.com

 

Information Request Form  &  Service Information Form

Your First Name: Middle: Last:    

E-mail address:
Mailing Street Address:
City:

State:
Zip:
Phone:
Please contact me about:  
Other Comments:
Pre-Planning Information For:
First Name:
 Middle:
Last Name:
Sex:  Male/ Female  Marital Status:
   Years of Education:
Date of Birth/Place of Birth: Social Security Number:
U. S. Veteran: Yes/No  Location of Military Discharge:
Street Address: City: State: Zip:
County:       Is home address in the city limits:  
Occupation:       Industry:  
Please list employers and career information to be listed for the public.
Spouse's First Name: Spouse's Last Name (Maiden & Last):
Mother's First Name:   Mother's Maiden & Last Name:
Father's First & Last Name:
Surviving Family Members: List spouse, children (and spouses), number of grandchildren, great grandchildren, & great great grandchildren, brothers and sisters (and spouses).  Include city & state for all of the above family members  
Family Members Who Have Preceded In Death: List spouse, children, grandchildren, great grandchildren, & great great grandchildren, brothers and sisters.     

Service Request:

Service Options:  Services including Traditional Burial    or    Services including Cremation
Place of Service:
Clergy Preference:
Name of Cemetery:
City: State: Section & Lot Number:  
Musical Requests:
Scripture & meaningful service literature requests:
Casket/Urn Bearers:
Other Requests: