Welcome To Schimdt Family Funeral Home

First Name:

Middle Name:

Last Name:

Address:

City/State:

Phone:

Date of Birth:

City/State of Birth:

SS #:

Veteran:

Yes No Branch: War:

Elementary/Secondary:

Schools Attended:

College:

Colleges Attended:

Occupation:

Yrs:
Retired When:

Organizations/Member of:

Father's Name:

Mother's Name:

Martial Status:

Married To:

Date & Place:

Is Spouse Living?:

If not, Date of Death:

Services to be held at:

Clergy Preference:

Casket Bearers:

Organist:

Soloist:

Favorite Hymns:

Cemetery Name/Locations:

Memorial Donation Preference:

Special Requests:

Family: Please list names and city of residence of family members.

Spouse:

Sons:

Daughters:

Grandchildren: Great Grandchildren: Great-Great Grandchildren:

Brothers:

Sisters:

Preceded in death by:

Comments or other wishes:

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