Advanced Planning Form

Provincial Registration of Death

Division of Vital Statistics

Name

Surname

Given Names

Date of Birth

Birthplace

City, Town, or Place of Birth

Province (or Country) of Birth

Usual Residence

Street Address

City, Town, Place

Postal Code

Province

Health Card Number

SIN

Sex

Marital Status

Status

Spouse Full Name (including maiden name if applicable)

Occupation

Kind of Work Done During Most of Working Life

Kind of Business or Industry

Father

Surname and Given Names of Father

Birthplace - City or Place, Province or Country

Mother

Surname and Given Names of Mother

Birthplace - City or Place, Province or Country

Executor or Next-of-Kin

Name

Address

Postal Code

Telephone Number

E-Mail

Relationship to Deceased

Alternate Contact

Name

Address

Postal Code

Telephone Number

E-Mail

Relationship to Deceased

Additional Information

Final Arrangements

Type of Final Arrangement

I request that my Event is to be conducted by:

If Other:

I request that my Event is to be held at (name of Church or Facility):

I would like a reception to follow:

I request my body be:

I wish that my cremated remains be:

Name and place of cemetery:

I wish to assist my executor by having Almassy Metz provide a personalized Estate Assistance Guide for his or her use:

Contact

regina@almassymetzfuneral.com

Phone:1-306-545-4455

Fax: 1-306-545-4453

Hours

We are always available and on call 24/7.

Office Hours:

Monday to Friday

9AM - 5PM

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