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416 Dibble St. West P.O. Box 1239 PRESCOTT, ON
(613) 925-3404 | Map & Directions

Online Funeral Planning

Online Arrangement Form
I. Biographical Information
Full Name:
Date of Death:
Address1:
Address2:
City Name:
Province:
Postal Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth:
(month/day/year)
City of Birth:
Province of Death:
Highest Education Level:                  
Please select Grade/Years of Education completed:                  
   
Social Security Number: For security reasons, we will contact you to complete
the pre-arrangement.
Residence History:                      
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence                      
Relatives Who Have Preceded You In Death                      
Your Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:
                   
II. Military Record
                 
Veteran:
Branch of Service:
Serial Number:
Date Enlisted:
(month/day/year)
Date of Discharge:
(month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):  
Time of Military Service:
Military Honours at Graveside:
Flag Preference for Service:
III. Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:                      
Pallbearers:                      
Flower Preference:                      
Music Selection:                      
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:
                   

Miscellaneous Notes and Instructions:

                

                       

                
                


Please select one of the options below:

                   

Please send me information on funeral planning

Please contact me to schedule an appointment

Please place my information on file

                   

                 
         

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MacKay Funeral Home 1652692 Ontario Inc. | 416 Dibble St. West P.O. Box 1239 | PRESCOTT, ON K0E 1T0 | Fax: (613) 925-5028 | Email: tim.mackay@mackayfuneralhome.com