Family Memorial Mortuary, Portland Oregon

FORM PREPARER
person receiving the arrangements:
name
soc. sec. #
birthplace
married status
gender
name of spouse
usual occupation
industry
residing state
county
city
street address
inside city limits?
zip code
Of Hispanic origin?
race
education level
father's name
mother's name
Type of Services: BURIAL
	Complete Funeral Service with Viewing
	Memorial Service with or without Viewing
	Graveside or Mausoleum Cryptside Service with or without viewing
	Family Gathering with Viewing
	Immediate Burial with or without Viewing
Type of Services: CREMATION
	Complete Funeral Service with Viewing - Cremation After Service and Viewing
	Memorial Service with or without Viewing - Cremation Before or After Service
	Nicheside Service with or without Viewing - Cremation Takes Pace BEfore Inurnment at Cemetery
	Family Gathering with Viewing - Cremation Follows After Gathering
	Direct Cremation with or without Viewing - Cremation done when paperwork is completed, and then scheduled with crematory
Type of Services: OTHER
	Ship Out of State to Other State
	Anatomical Donation to O.H.S.U., Please mark a second service, if donation is not accepted.
SERVICE INFORMATION
location
officiant
songs
additional
OBITUARY INFORMATION
length of time in area
came from
religion
member of church
marriage
graduated
worked for
retired
other	(memberships, hobbies, achievements, etc.)
SURVIVED BY
spouse
marriage
death
children	(names, with city, state after each)
father
mother
brothers	(names, with city, state after each)
sisters	(names, with city, state after each)
others	(others - list relationship for each: names, with city, state after each)
grand- children
great- grandchildren
great-great- grandchildren

Please fill in the blanks with information for the person receiving pre-
arrangements or download and fill out
the forms below:

CLICK HERE
FOR BURIAL
INTAKE FORM:

252 K PDF

CLICK HERE
FOR CREMATION
INTAKE FORM:

252 K PDF

CLICK HERE
FOR PRE-ARRANGEMENTS
INTAKE FORM:

252 K PDF