Sample Funeral Program Template

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Davis-Monthan Honor Guard
DAVIS-MONTHAN AIR FORCE BASE, ARIZONA
(520) 228-4189/ Fax (520) 228-5991
NOTE: The Davis-Monthan Honor Guard will provide Military Funeral Honors for individuals that served in the following
services: Army Air Corps (AC), Army Air Force (AAF), Air National Guard (ANG), Women’s Air Force Service Pilots
(WASP). Air Force Reservist (AF Res) & the Air Force (AF).
1.
Name of deceased:__________________________________________________________________
Rank:_____________________Branch:________________________SSN:_____________________
2.
Veteran, Retiree, Active Duty (please circle below)
-
Urn
Casket
Memorial
No Urn or Casket
Please circle below which services are to be provide by the Davis-Monthan Honor Guard:
Veterans: Flag Folding Ceremony / Taps
Retirees: Pallbearers / Flag Folding Ceremony / Firing Party / Taps
Active Duty: Pallbearers / Flag Folding / Seven Man Rifle Party / Color Guard / Taps
3.
Name & address of funeral home / mortuary / cemetery: __________________________________
_________________________________________________________________________________
4.
Full name of case worker or whoever is assisting with arrangements and phone number including area code:
___________________________________________________________________
5.
Name and address of cemetery or site for Military Funeral Honors to be performed:
If honors are conducted at gravesite, is the cemetery National/State/Private (please circle)
_________________________________________________________________________________
6.
Time and date for military funeral honors:
_________________________________________________________________________________
NOTE: The Time & Date for Military Funeral Honors should be the time that the Military Honors are being
requested, not the time of the memorial service unless the family is requesting Military Funeral Honors then. Please
be as exact as possible.
7.
Next of kin name and relationship to deceased:
____________________________________________________________________________________
8.
Next of kin phone number and address (please include area code and zip code):
____________________________________________________________________________________
9.
Who will receive the flag and relationship to the deceased:
_________________________________________________________________________________
Note: Flag for presentation to next of kin or substitute will not be provided by the Honor Guard. Next of kin may obtain a
flag from the following locations: Funeral Home, Mortuary, Cemetery or Local Post Office with a copy of DD form 214
and any other required forms.
NOTE: INFORMATION IN THE ABOVE IS COVERED UNDER THE PRIVACY ACT OF 1974. ALL INFORMATION
IS TO BE USED ONLY FOR OFFICIAL USE AND BUSINESS.
- To Honor, With Dignity -
DMHG-FORM1
1)
How do you load your caskets in the hearse? Feet first head to the rear of the hearse_______, or head first feet to
the rear of the hearse_______. (We prefer feet first head to the rear of the hearse)
2)
Has the deceased committed or been convicted of a state or capital crime_______. (Funeral director initials)

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