Funeral Planning GuideMemorial Instructions (please print)NAME First_______________________Middle_____________Last_______________________ Nickname________________________Maiden Name____________________________ Social Security Number______________________Home Phone____________________ Business Phone_____________________________Other__________________________
ADDRESS Street___________________________County___________City____________________ Resident Since____________________Previous City & State_______________________ In city since_________County_________State since_________Country since__________ PERSONAL INFORMATION Birth Date__________________Birth Place_____________________Sex: M____F____ Nationality/Citizenship__________________High School Completed________________ Employed by (or retired from)________________________________________________ Job Title_________________________________________________________________ Marital Status___________________Date____________Location___________________ Spouse's Name___________________________________________________________ Name of father_______________________Maiden Name of mother_________________ Father's birthplace____________________Mothers birthplace______________________ Father's address______________________Mother's address________________________
If a Veteran, Please Complete the Following: Branch of Service___________________________Serial Number___________________ Rank at time of discharge_____________________Discharge date/location___________
Memberships (union, fraternal, business, etc.) _________________________________________________________________________ Religious affiliation________________________________________________________ _______________________________________________________________________ ESTATE/FINANCIAL INFORMATION Do you have a living will or trust? Yes____No____Location_______________________ Attorney/POA:___________________________________________________________ Banks___________________________________________________________________ _______________________________________________________________________ CD's Annuities___________________________________________________________ Life Insurance___________________________Policy No._________________________ Health Insurance_________________________Policy No._________________________ Hospital________________________________Phone____________________________ Physician_______________________________Phone____________________________ FUNERAL INSTRUCTIONS Preferred Funeral Home_____________________________Phone__________________ Church Preference_________________________________Phone___________________ Officiant________________________________________Phone___________________ Disposition Preference: Burial______Cremation______Deliver______ Family Pick-up______Ship______Hold______Other_____________________________ Service to be held at: Mortuary______________________Church__________________ Chapel________________________________Graveside__________________________ Friends calling: Yes______No______Casket: Opened______ Closed______ Participating fraternal, military or service organizations: ___________________________ _______________________________________________________________________ Obituary: Yes____No____ Newspapers:_______________________________________ Pallbearers to be selected by:_________________________________________________ Casket: ________________________________Vault____________________________ Flowers (type)____________________________________________________________ Favorite literature or religious passage/verse:____________________________________ Specific requests to be performed at service: ____________________________________ _______________________________________________________________________ Contributions:____________________________________________________________ Flag (if veteran) Folded______ Draped ______ Given to _________________________ Specific clothing__________________________________________________________ Glasses?__________ Jewelry?_________________________________ Cemetery property owned: Yes_____No ______ Cemetery_________________________ Location: Space ________ Lot ________ Vault ________ Marker________ City____________________________________________State____________________ Cremation: Niche ________ Urn ________ Urn vault ________ Additional Instructions: ____________________________________________________ _______________________________________________________________________ _______________________________________________________________________ The preceding information represents my personal wishes and desires for the purpose of assisting my family in making funeral and burial arrangements at the time of need. As of this date, I would prefer that my family spend $___________ for my funeral and burial arrangements.
Signature________________________________________Date____________________ Counselor_______________________________________Date_____________________ (Print out and keep with personal records) |