MacKenzie Funeral Chapel

130 9th Street East

Prince Albert, SK S6V 0X5

Phone: 306.763.8488

Fax: 306.763.0800

Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

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 Birth:
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:	Enter Text Here...
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	Enter Text Here...
Relatives Who Have Preceded In Death	Enter Text Here...
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):	Enter Text Here...
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:
III. Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:	List Clergy Here...
Pallbearers:	List up to eight pallbearers
Flower Preference:	Enter Flower Preference...
Music Selection:	Enter 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: Enter Text Here...
Please select one of the options below: Please send me information Please contact me to schedule an appointment Please place my information on file

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