J.L. Getts & Co.
Pre-planning a Funeral
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Below is a list of the information
required to help us start your pre-arrangements.  

J.L. Getts & Co.
Funeral Homes in Miamisburg & Dayton

Pre-Arrangement Questionaire for _________________________

(Your Name)


I would like to:
 have a traditional funeral service followed by burial at _________________________
 have a traditional funeral service followed by cremation.
 have a simple dignified graveside committal service only.
q be cremated as soon as possible after my death.

I would like my funeral services to be held at:
 Brough-Getts Funeral Home in Miamisburg, Ohio
q my church____________________________________    

q the graveside only

q Other _______________________________________

If possible I wish to have:
q a viewing for friends & family     

q private viewing for family members only
q a closed casket visitation and/or funeral

My Clergy/Minister is __________________________

Church  ___________________________


I would like my casket to:
q constructed of steel  q constructed of wood   

q constructed of fiberglass q constructed of copper or bronze  q Other ___________________________________

 I would like the color of my casket to:
q Silver   q brown   q blue   q white  q pink  q green   

q gold   q other ___________________________________

My grave is located at _____________________Cemetery in _________________________________________________


My cremains are to be place in : q an urn constructed of quality metals  q urn constructed of wood  q urn suitable for burial   q other ____________________________________



My address is _____________________________________


Home phone (_____) _______________________________

Cell phone (_____) _________________________________

E-mail ___________________________________________

My closest family member or friend is __________________

Their phone number is (_____) _______________________

Their address is ____________________________________


My Social Security number is _____ - ____ - __________ 

My date of birth is _______________
I was born at ______________________

I am married to ___________________________________
I was married (date) _______________________________

My occupation : ___________________________________

My employer is : ___________________________________

My Attorney is_____________________________________
My life insurance is with______________________________
My life insurance policy number is______________________

I q am not  q am a veteran of the US Armed Forces  

Would you like to set an appointment to pre-arrange your final wishes in person at our funeral home?  q yes   q no
Do you need to buy a grave(s)?  
q yes   q no

Do you need to purchase a  monument?  q yes  q no

Would you like to receive spiritual help? q yes   q no


Would you like to speak with someone regarding estate planning? q yes   q no


Would you like to speak with someone regarding your personal or family finances ?  q yes   q no


Please feel free to make a copy of this form for your own records, or you may send us a copy of this form for us to keep on file. There is no charge for us to establish a pre-arranged funeral file for you. If you are desirous of guaranteeing current prices for you final wishes, we have several options for pre-payment which will accomplish that for you. We are available 24 hours a day - 365 days a year to serve you in any capacity regarding your memorialization arrangements If we can assist you in any way please call us at (937) 866-1001 or 1-800-786-1892 Fax (937)847-9128


Got a question? Send us an e-mail - click here.


J.L. Getts & Co. Inc.

Brough-Getts Funeral Home

102 S. Second St. Miamisburg, Ohio 45342 (937) 866-1001

Walter-Getts Funeral Home

1235 N. Main St. Dayton, Ohio 45405 (937) 228-5181