{"id":784,"date":"2017-11-22T18:20:43","date_gmt":"2017-11-22T18:20:43","guid":{"rendered":"http:\/\/comeaufuneral.com\/?page_id=784"},"modified":"2026-01-22T20:15:40","modified_gmt":"2026-01-22T20:15:40","slug":"prearrangements-form","status":"publish","type":"page","link":"https:\/\/comeaufuneral.com\/2025-1\/prearrangements-form\/","title":{"rendered":"Prearrangements Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<h2 class=\"sc_title sc_title_regular sc_align_center fig_border\" style=\"margin-top:0px;text-align:center;\">Prearrangements Form<\/h2>[vc_column_text]<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_4_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_contact-form32\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Prearrangements Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"4\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"contact-form32\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"be40a9ed3a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/2025-1\/wp-json\/wp\/v2\/pages\/784\" \/><div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy32\" id=\"field_qh4icy32_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy32\" name=\"item_meta[16]\" value=\"\"  data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy32\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qh4icy32\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half\">\r\n    <label for=\"field_ocfup132\" id=\"field_ocfup132_label\" class=\"frm_primary_label\">Last\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup132\" name=\"item_meta[17]\" value=\"\"  data-reqmsg=\"Last cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup132\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ocfup132\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ec71l\" id=\"field_ec71l_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_ec71l\" name=\"item_meta[72]\" value=\"\"  data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n    <label for=\"field_29yf4d32\" id=\"field_29yf4d32_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d32\" name=\"item_meta[18]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n    <label for=\"field_e6lis632\" id=\"field_e6lis632_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e6lis632\" name=\"item_meta[19]\" value=\"\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Subject is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_3sahg\" id=\"field_3sahg_label\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_3sahg\" name=\"item_meta[21]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qdlyw\" id=\"field_qdlyw_label\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qdlyw\" name=\"item_meta[22]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uk34k\" id=\"field_uk34k_label\" class=\"frm_primary_label\">Zip Code\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_uk34k\" name=\"item_meta[23]\" value=\"\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_t9pnr\" id=\"field_t9pnr_label\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_t9pnr\" name=\"item_meta[25]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_q0c3m\" id=\"field_q0c3m_label\" class=\"frm_primary_label\">Place of Birth\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[26]\" id=\"field_q0c3m\" rows=\"5\"  data-invmsg=\"Place of Birth is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9bd2v\" id=\"field_9bd2v_label\" class=\"frm_primary_label\">Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_9bd2v\" name=\"item_meta[27]\" value=\"SSN#\"  data-frmval=\"SSN#\" data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rnsv4\" id=\"field_rnsv4_label\" class=\"frm_primary_label\">Father's Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rnsv4\" name=\"item_meta[28]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_1kwda\" id=\"field_1kwda_label\" class=\"frm_primary_label\">Father's Place of Birth\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1kwda\" name=\"item_meta[29]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7prb8\" id=\"field_7prb8_label\" class=\"frm_primary_label\">Mother's Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7prb8\" name=\"item_meta[30]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gt4p\" id=\"field_gt4p_label\" class=\"frm_primary_label\">Mother's Place of Birth\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gt4p\" name=\"item_meta[31]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_scoez\" id=\"field_scoez_label\" class=\"frm_primary_label\">Mother's Maiden Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_scoez\" name=\"item_meta[32]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_t9zzg\" id=\"field_t9zzg_label\" class=\"frm_primary_label\">Dropdown\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[34]\" id=\"field_t9zzg\"  data-frmval=\"Married\" data-invmsg=\"Dropdown is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Married\" selected='selected'>Married<\/option><option  value=\"Never Married\">Never Married<\/option><option  value=\"Divorced\">Divorced<\/option><option  value=\"Widow\">Widow<\/option><option  value=\"Widower\">Widower<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_c1lis\" id=\"field_c1lis_label\" class=\"frm_primary_label\">Spouse's Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c1lis\" name=\"item_meta[35]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hzqij\" id=\"field_hzqij_label\" class=\"frm_primary_label\">Spouse's Maiden Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hzqij\" name=\"item_meta[36]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2f6i3\" id=\"field_2f6i3_label\" class=\"frm_primary_label\">Place of Marriage\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[37]\" id=\"field_2f6i3\" rows=\"5\"  data-invmsg=\"Place of Marriage is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_o4iwu\" id=\"field_o4iwu_label\" class=\"frm_primary_label\">Date of Marriage\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_o4iwu\" name=\"item_meta[38]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9ah1h\" id=\"field_9ah1h_label\" class=\"frm_primary_label\">Additional Family Members\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[39]\" id=\"field_9ah1h\" rows=\"5\"  data-invmsg=\"Additional Family Members is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_9ah1h\"><\/textarea>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_9ah1h\">Please use the area above to enter the names of siblings, children and grandchildren.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_s183y_label\" class=\"frm_primary_label\">Education Level\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_s183y_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_40-0\">\t\t\t<label  for=\"field_s183y-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_s183y-0\" value=\"Grade School\"  data-invmsg=\"Education Level is invalid\"   \/> Grade School<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_40-1\">\t\t\t<label  for=\"field_s183y-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_s183y-1\" value=\"High School\"  data-invmsg=\"Education Level is invalid\"   \/> High School<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_40-2\">\t\t\t<label  for=\"field_s183y-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_s183y-2\" value=\"Degree\"  data-invmsg=\"Education Level is invalid\"   \/> Degree<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_40-3\">\t\t\t<label  for=\"field_s183y-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_s183y-3\" value=\"Masters Degree\"  data-invmsg=\"Education Level is invalid\"   \/> Masters Degree<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_40-6\">\t\t\t<label  for=\"field_s183y-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[40][]\" id=\"field_s183y-6\" value=\"Doctorate\"  data-invmsg=\"Education Level is invalid\"   \/> Doctorate<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_mqt5y\" id=\"field_mqt5y_label\" class=\"frm_primary_label\">Occupation\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mqt5y\" name=\"item_meta[41]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_77pq4\" id=\"field_77pq4_label\" class=\"frm_primary_label\">Company Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_77pq4\" name=\"item_meta[42]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_p8jdw\" id=\"field_p8jdw_label\" class=\"frm_primary_label\">Business Field\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p8jdw\" name=\"item_meta[43]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_16yv6_label\" class=\"frm_primary_label\">Did You Serve in the Milatary?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_16yv6_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_44-0\">\t\t\t<label  for=\"field_16yv6-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[44][]\" id=\"field_16yv6-0\" value=\"Yes\"  data-invmsg=\"Did You Serve in the Milatary? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_44-1\">\t\t\t<label  for=\"field_16yv6-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[44][]\" id=\"field_16yv6-1\" value=\"No\"  data-invmsg=\"Did You Serve in the Milatary? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4necf\" id=\"field_4necf_label\" class=\"frm_primary_label\">Branch of Service\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4necf\" name=\"item_meta[45]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_umwzp\" id=\"field_umwzp_label\" class=\"frm_primary_label\">Serial Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_umwzp\" name=\"item_meta[47]\" value=\"\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yesn7\" id=\"field_yesn7_label\" class=\"frm_primary_label\">Date Entered Service\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yesn7\" name=\"item_meta[46]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9d8w0\" id=\"field_9d8w0_label\" class=\"frm_primary_label\">Rank at Discharge\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9d8w0\" name=\"item_meta[48]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_opg9h\" id=\"field_opg9h_label\" class=\"frm_primary_label\">Date Discharged\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_opg9h\" name=\"item_meta[49]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_o04zy\" id=\"field_o04zy_label\" class=\"frm_primary_label\">Discharge on file at:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_o04zy\" name=\"item_meta[50]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_51_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_4iasj_label\" class=\"frm_primary_label\">Do you have a copy of the discharge papers?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_4iasj_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_51-0\">\t\t\t<label  for=\"field_4iasj-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[51][]\" id=\"field_4iasj-0\" value=\"Yes\"  data-invmsg=\"Do you have a copy of the discharge papers? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_51-1\">\t\t\t<label  for=\"field_4iasj-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[51][]\" id=\"field_4iasj-1\" value=\"No\"  data-invmsg=\"Do you have a copy of the discharge papers? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_52_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_b5ikq\" id=\"field_b5ikq_label\" class=\"frm_primary_label\">Wars Fought In:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[52]\" id=\"field_b5ikq\" rows=\"5\"  data-invmsg=\"Wars Fought In: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_qy1b7\" id=\"field_qy1b7_label\" class=\"frm_primary_label\">Person in Charge:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qy1b7\" name=\"item_meta[53]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_a5ap3\" id=\"field_a5ap3_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[54]\" id=\"field_a5ap3\" rows=\"5\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_agxzr_label\" class=\"frm_primary_label\">Place of Funeral Service\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_agxzr_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-0\">\t\t\t<label  for=\"field_agxzr-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_agxzr-0\" value=\"Funeral Home\"  data-invmsg=\"Place of Funeral Service is invalid\"   \/> Funeral Home<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-1\">\t\t\t<label  for=\"field_agxzr-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_agxzr-1\" value=\"Church\"  data-invmsg=\"Place of Funeral Service is invalid\"   \/> Church<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_55-2\">\t\t\t<label  for=\"field_agxzr-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[55][]\" id=\"field_agxzr-2\" value=\"Cemetary\"  data-invmsg=\"Place of Funeral Service is invalid\"   \/> Cemetary<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_56_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_273y1\" id=\"field_273y1_label\" class=\"frm_primary_label\">Place of Visitation\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[56]\" id=\"field_273y1\" rows=\"5\"  data-invmsg=\"Place of Visitation is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_57_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_77vh9\" id=\"field_77vh9_label\" class=\"frm_primary_label\">Religious Denomination\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_77vh9\" name=\"item_meta[57]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_eute2\" id=\"field_eute2_label\" class=\"frm_primary_label\">Place of Worship\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_eute2\" name=\"item_meta[58]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_xe86n\" id=\"field_xe86n_label\" class=\"frm_primary_label\">Lodge\/Union\/Assoc. Membership\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[59]\" id=\"field_xe86n\" rows=\"5\"  data-invmsg=\"Lodge\/Union\/Assoc. Membership is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_60_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_u9n96\" id=\"field_u9n96_label\" class=\"frm_primary_label\">Person in charge of final arrangements\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u9n96\" name=\"item_meta[60]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_61_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_9cau0_label\" class=\"frm_primary_label\">Disposition Request: I Prefer\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_9cau0_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_61-0\">\t\t\t<label  for=\"field_9cau0-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[61][]\" id=\"field_9cau0-0\" value=\"Earth Burial\"  data-invmsg=\"Disposition Request: I Prefer is invalid\"   \/> Earth Burial<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_61-1\">\t\t\t<label  for=\"field_9cau0-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[61][]\" id=\"field_9cau0-1\" value=\"Mausoleum\"  data-invmsg=\"Disposition Request: I Prefer is invalid\"   \/> Mausoleum<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_61-2\">\t\t\t<label  for=\"field_9cau0-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[61][]\" id=\"field_9cau0-2\" value=\"Cremation\"  data-invmsg=\"Disposition Request: I Prefer is invalid\"   \/> Cremation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_61-4\">\t\t\t<label  for=\"field_9cau0-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[61][]\" id=\"field_9cau0-4\" value=\"Other\"  data-invmsg=\"Disposition Request: I Prefer is invalid\"   \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_62_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_timvm\" id=\"field_timvm_label\" class=\"frm_primary_label\">Cemetery\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[62]\" id=\"field_timvm\" rows=\"5\"  data-invmsg=\"Cemetery is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_63_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_jt6pr\" id=\"field_jt6pr_label\" class=\"frm_primary_label\">Lot #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_jt6pr\" name=\"item_meta[63]\" value=\"\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_jt6pr\" min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_jt6pr\">(if applicable)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_64_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_roplv\" id=\"field_roplv_label\" class=\"frm_primary_label\">Section\/Letter\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_roplv\" name=\"item_meta[64]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_roplv\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_roplv\">(if applicable)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_65_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uhvk4\" id=\"field_uhvk4_label\" class=\"frm_primary_label\">Grave #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_uhvk4\" name=\"item_meta[65]\" value=\"\"  data-invmsg=\"Number is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_uhvk4\" min=\"0\" max=\"9999999\" step=\"any\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_uhvk4\">(if applicable)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_66_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rvj8g\" id=\"field_rvj8g_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[66]\" id=\"field_rvj8g\" rows=\"5\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_67_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_ted2c_label\" class=\"frm_primary_label\">I have made a last will and testament\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ted2c_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_67-0\">\t\t\t<label  for=\"field_ted2c-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[67][]\" id=\"field_ted2c-0\" value=\"Yes\"  data-invmsg=\"I have made a last will and testament is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_67-1\">\t\t\t<label  for=\"field_ted2c-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[67][]\" id=\"field_ted2c-1\" value=\"No\"  data-invmsg=\"I have made a last will and testament is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_68_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_vqxqo\" id=\"field_vqxqo_label\" class=\"frm_primary_label\">Location of Will\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[68]\" id=\"field_vqxqo\" rows=\"5\"  data-invmsg=\"Location of Will is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_7lszr\" id=\"field_7lszr_label\" class=\"frm_primary_label\">Additional instructions for us\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[69]\" id=\"field_7lszr\" rows=\"5\"  data-invmsg=\"Additional instructions for us is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_per85\" id=\"field_per85_label\" class=\"frm_primary_label\">Memorial requests or donations to charity\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[70]\" id=\"field_per85\" rows=\"5\"  data-invmsg=\"Memorial requests or donations to charity is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_71_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_7sqtn_label\" class=\"frm_primary_label\">Please select from one of the options below:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_7sqtn_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_71-0\">\t\t\t<label  for=\"field_7sqtn-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[71][]\" id=\"field_7sqtn-0\" value=\"Send me information about pre-arrangements\"  data-invmsg=\"Please select from one of the options below: is invalid\"   \/> Send me information about pre-arrangements<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_71-1\">\t\t\t<label  for=\"field_7sqtn-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[71][]\" id=\"field_7sqtn-1\" value=\"Contact me to set up an appointment\"  data-invmsg=\"Please select from one of the options below: is invalid\"   \/> Contact me to set up an appointment<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_71-2\">\t\t\t<label  for=\"field_7sqtn-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[71][]\" id=\"field_7sqtn-2\" value=\"No appointment needed just keep my request and information on file\"  data-invmsg=\"Please select from one of the options below: is invalid\"   \/> No appointment needed just keep my request and information on file<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_216_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_217_container\">\n\t\t\t<label for=\"field_adgs4\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_adgs4\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[217]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"drz7jR9aE8ezQ1kgHX0w1UBid07nMz1Qg39S2PV1i64=\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text][\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-784","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/pages\/784","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/comments?post=784"}],"version-history":[{"count":5,"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/pages\/784\/revisions"}],"predecessor-version":[{"id":6811,"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/pages\/784\/revisions\/6811"}],"wp:attachment":[{"href":"https:\/\/comeaufuneral.com\/2025-1\/wp-json\/wp\/v2\/media?parent=784"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}