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Peake Funeral Chapel & Cremation Services
1925 SE Scott Street
Milwaukie, OR, 97222
Phone: (503) 654-7755

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Immediate Need Online Planning Form

Let us take a moment to say we are so sorry for your loss. We hope that you will find this section of our website helpful in this difficult time. You can get a head start on the arrangement 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:
Address 1:
Address 2:
City Name:
State:
Zip Code:
Telephone Number:
(xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
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 In Death
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 Honors 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

Please contact me to schedule an appointment

Please place my information on file


 

 

 

 

 

 

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Proudly Serving the Communities of Milwaukie, Oak Grove, Gladstone, Clackama, and Oregon City
(503) 654-7755 1925 SE Scott Street, Milwaukie, OR 97222 | Fax: (503) 654-8530 (503) 654-7755 Peake Funeral Chapel & Cremation Services
1925 SE Scott Street
Milwaukie, OR 97222
Fax: (503) 654-8530
Email: sgrab@stonemor.com
(503) 654-7755 Peake Funeral Chapel & Cremation Services
1925 SE Scott Street
Milwaukie, OR 97222
Fax: (503) 654-8530
Email: sgrab@stonemor.com
(503) 654-7755 Peake Funeral Chapel & Cremation Services
1925 SE Scott Street
Milwaukie, OR 97222
Fax: (503) 654-8530
Email: sgrab@stonemor.com
(503) 654-7755 Peake Funeral Chapel & Cremation Services
1925 SE Scott Street
Milwaukie, OR 97222
Fax: (503) 654-8530
Email: sgrab@stonemor.com