Pre-Arrange Online

Pre-Arrange Online

Name:

Name at Birth:

Gender:

Race:

Ancestory:

Social Security Number:

Highest Education:

Residence Address:

City:

State:

ZipCode:

In City Limits:

Email Address:

Phone:

Occupation:

Type of Business/Industry:

Date of Birth:

Birthplace:

Marital Status:

Surviving Spouse (Maiden Name):

Marriage City and State

Marriage Date:

Father's Name:

Mother's Name (Maiden)

Next of Kin:

Relationship:

Phone:

Address:

City:

State:

ZipCode:

Survivors:

No. of Grandchildren

No. of Great Grandchildren

Church for Service:

Minister:

Hymns:

Preferred Method of Contact:

Email

Phone

Office: 308-254-2055, 1-855-254-9500

Gehrig-Stitt Chapel & Cremation Service, LLC

Stitt Monument & Funeral Planning, LLC

1140 10th Avenue P.O. Box 151 Sidney NE 69162

director@gehrigstittchapel.com

1212 10th Avenue, P.O. Box 151 Sidney NE 69162

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