Immediate Need | Griffiths-Hovendick Chapel

Many decisions are being made when someone you loved passes away. We are here to offer support in any way we can. If you would like to start by filling out this form online, please do so. We are also here to meet in person. Please call us to setup a meeting with one of our experienced funeral directors (402) 223-3521

Please note that your information is saved on our server as you enter it.

Pre-planning with us

Your Information

Your Information

Your First Name

Your Last Name

Email:

Phone:

Free Text

If you are not responsible for arrangements, let us know who will be

First Name

Last Name

Email

Phone Number

Deceased's Information

Deceased's Information

First Name

Last Name

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Are you a legal representative of this individual?(Required) ie. Power of attorney for healthcare, court appointed personal representative, etc.

Yes

No

Birth Place

Gender

Male

Female

Other

Ethnicity

Marital Status:

Married

Single

Widowed

Birth Date

City of Birth

State of Birth

Country of Birth

Country of Death

Place of Death

Occupation

industry

Please Specify Address

Please Specify Address

Street Address

City

State

ZIP Code

Family Information

Family Information

Surviving Spouse

Maiden Name

Any other information?