Wallace Family Funeral Home Pre-Need
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Many times it is very difficult for family or friends to make the many decisions required after the death of a loved one. Pre-arranging the service details, including your wishes on being an organ and tissue donor, will lessen the number of decisions that will need to be made during the emotional time immediately following a death.

As a staff we are here to listen to you and your family's concerns, then help you plan services that will honor and celebrate your unique life, but that will also be meaningful to your family.

Service may be pre-funded as well as pre-planned. We offer different pre-funding options through the Homesteaders Life Company located in Des Moines, Iowa. By using Homesteaders Life Company, your pre-funding guarantees your service into the future, and it will be irrevocable, a requirement of Title 19.

We can also help you transfer your pre-arrangements and pre-funding from another funeral service provider to our funeral home or from our funeral home to another funeral service provider.

If you would like to leave your wishes with us or like more detailed information complete the following Online Pre-need Information form.

Online Pre-Need Form

Your Full Name:


Your Email Address:


Your Maiden Name:


Street/Mailing Address:


City:


State:


Date of Birth:


Place of Birth:


Social Security Number:


Spouses Name:


 
Spouse Survived?
Yes     No

Marital Status:


Date of Marriage:


Place of Marriage:


Names of Previous Spouses:


Names of Parents:


Address of Parents (if still living):


Names of Children:


Addresses and Phone numbers of Children:


Names of Brothers and Sisters:


Addresses and Phone numbers of Brothers and Sisters:


Names of other friends and relatives who should be notified:


Addresses and Phone numbers of other friends and relatives:


Occupation:


Names of present and previous employers:


Addresses and Phone numbers of present and previous employers:


  
If you are a veteran
Date of enlistment:


Place of enlistment:


Date of discharge:


Place of discharge:


Rank:


Service Numbers:


Organization or outfit:


Commendations received:


Location of discharge papers:


Flag desired to drape casket:



Religious affiliation:


Professional and fraternal organization memberships:


Education (list schools attended and dates of any degrees or honors received):


Names of newspapers for obituary:


Organ Donation (list of authorized card and anyone who should be notified):


Funeral director or funeral home you prefer:


Clergyperson or anyone else you would like to officiate:


Funeral Service Location:


Visitation instructions:


Music, hymns or readings you would prefer during your service:


Memorial Donations you would like in your memory:


Names and Addresses and Phone Numbers of casket bearers:


Cemetery Name:


Address and location of cemetery property (include lot and grave number):


Casket and/or vault preference:


If you wish to be cremated, include disposition preference:


Location of will:


The name of the executor of your estate:


Address and phone number of the executor of your estate:


Location of safety deposit box and key:


Attorney's name:


Attorney's address and phone number:


Location of checking accounts, checkbooks, savings accounts and passbooks:


Credit cards and charge accounts to be canceled. (For security purposes do not list Credit Card Numbers here, just the names of cards.)


Insurance company name and policy numbers:


Location of insurance policies:


Any additional instructions:



 
Wallace Family Funeral Home
1115 E. 19th St. N.,
Newton, IA 50208-2539
Toll Free: 1-877-787-9911
Phone: 641-787-9911
Fax: 641-787-9208
staff@wallacefamilyfuneralhome.com

 

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