Matinchek Funeral Home

260 East Main Street

Middletown, PA 17057

Phone: 717-944-7015

Fax: 717-944-7024

Email: Zac@matinchekfh.com

Immediate Need

If you have immediate need of our services, we're available for you 24 hours a day.

Pre-Arrangement

A gift to your family, sparing them hard decisions at an emotional time.

Order Flowers

Offer a gift of comfort and beauty to a family suffering from loss.

Remembrance Process

We pledge to treat you and your family with the utmost respect and to help you in your time of need.

Online At-Need Funeral Planning

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

I. Biographical Information

Full Name:

Date of Death:

Address1

Address2:

City Name:

State:

Zip Code:

Telephone Number: (xxx-xxx-xxxx)

Email Address:

Date of Birth: (month/day/year)

City of Birth:

State of Birth:

Highest Education Level:

Please select Grade/Years of Education completed:

Social Security Number:

For security reasons, we will contact you to complete the pre-arrangement.

Residence History:

Father's Name:

Father's City of Residence:

Mother's Name:

Mother's City of Residence:

Mother's Maiden Name:

Spouse's Name:

Spouse's Maiden Name:

Survivors' Names and Cities of Residence

Relatives Who Have Preceded In Death

Occupation:

Business Type:

Company Name:

Church Membership:

Lodge or Union Name:

II. Military Record

Veteran:

Branch of Service:

Serial Number:

Date Enlisted: (month/day/year)

Date of Discharge: (month/day/year)

Rank at Discharge:

Location of a Copy of Discharge (DD214):

Time of Military Service:

Military Honors at Graveside:

Flag Preference for Service:

III. Service Preferences

Type of Service:

Visitation Hours:

Casket:

Person in Charge of Arrangements:

Officiating Clergy:

Pallbearers:

Flower Preference:

Music Selection:

Jewelry:

Glasses:

Casket Preference:

Disposition:

Outer Container Preference: (for ground burial)

Cemetery Name:

Cemetery Location:

The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

Please select one of the options below:
Please send me information
Please contact me to schedule an appointment
Please place my information on file

Matinchek Funeral Home

Order Flowers

Immediate Need

Pre-Arrangement

Order Flowers

Remembrance Process

Online At-Need Funeral Planning

Social Security Number:

52 Weeks of Support