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Davis Funeral Homes & Memorial Park

To be placed in the permanent files of Davis Funeral Homes & Memorial Park.
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Person Completing this Form*:
Pre-arrangement Guide For
Full Legal Name*:
(no initials please)
(no P.O. Box)
Date of Birth:
Place of Birth:
Father's Full Name:
Mother's Full Maiden Name:
Highest Level of Education Completed:
Veteran: Yes No
Military Branch:
Dates of Service:
Spouse's Full Name:
(Wife's maiden name, if applicable)
Religious Affiliation/Congregation:
Family Member Information

Family Member #1

Funeral Arrangement Details
Person in charge of arrangements:
Place of service or gathering:
If Other, please specify:


Preference for final disposition:
If Other, please specify:
Disposition of cremated body:

In the space provided below, please share any information that would be helpful in creating a meaningful service. (ie. favorite hobbies, places, music selections, poems, scripture, etc.)

Any final thoughts that should be shared?


Do you wish to be contacted to discuss the details
of these arrangements, cost or payment options? Yes No

If yes, how should we contact you:
Phone Number:

If no, we will keep this information on file until you or your surviving family requests it.

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Enter Security Code:

Ronald Link
Born: 12/13/1948
Died: 8/25/2016
William Miller
Born: 1/31/1928
Died: 8/23/2016
Rakhil Bizova
Born: 2/22/1919
Died: 8/22/2016
Frank Uyeda
Born: 8/1/1922
Died: 8/21/2016
David Moldt
Born: 8/27/1947
Died: 8/19/2016
Aylin Ruano Escoto
Born: 12/4/2015
Died: 8/15/2016
Rev. Edward Anderson, C.S.V.
Born: 12/29/1921
Died: 8/14/2016
Jacquelyn Bourgeois
Born: 1/21/1943
Died: 8/13/2016
Candace Ortiz, DPT
Born: 1/30/1989
Died: 8/12/2016

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Davis Funeral Homes & Memorial Park | 6200 South Eastern Avenue | Las Vegas, NV 89119 | 702-736-6200
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