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Davis Funeral Homes & Memorial Park

To be placed in the permanent files of Davis Funeral Homes & Memorial Park.
*Require fields

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.

  security code
Enter Security Code:

Helen Stetson
Born: 8/23/1936
Died: 10/17/2016
Leonardo Deocampo Jr.
Born: 3/25/1945
Died: 10/17/2016
Rebecca Rosa
Born: 11/13/1938
Died: 10/16/2016
Mario Bellardi
Born: 5/15/1921
Died: 10/16/2016
Elisa Martin
Born: 10/11/1945
Died: 10/15/2016
James Caudill
Born: 1/2/1963
Died: 10/15/2016
Richard Walsh
Born: 5/24/1933
Died: 10/14/2016
Herbert Smith
Born: 10/5/1948
Died: 10/6/2016
Vernette Langley
Born: 1/9/1942
Died: 10/3/2016

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