Name:

Date:

Dear loved ones:

In the pages that follow, I’ve recorded my desires and preferences regarding decisions you’ll be asked to make after my death. Please read through this entire document before making arrangements for my funeral.

Upon my death, I want to donate my organs as indicated:

______Any needed organs or body parts

______No Donation

______Only those organs or body parts listed

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______I have a Living Will (location)

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Notification:

Please let all these people know of my death:
Spouse (telephone number)
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Children (full names and telephone numbers)
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Parents (names and telephone numbers)
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Siblings (full names and telephone numbers)
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Friends (full names and telephone numbers)
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Business Associates (names and telephone numbers)
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Place of Worship (include telephone number)
__________________________________________________________________________________
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This is who I want to handle my funeral:

Funeral Director:____________________________________________________________________

Funeral Home:______________________________________________________________________

Address:_____________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Please ask these loved ones to be my pallbearers:
__________________________________________________________________________________
__________________________________________________________________________________
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Details of my funeral:

Speaker:__________________________________________________________________________

Location of Funeral:_________________________________________________________________

Location of Burial:___________________________________________________________________

I prefer:

____Flowers
____Tributes to (charity or organization)
__________________________________________________________________________________
__________________________________________________________________________________

Favorite Music
__________________________________________________________________________________
__________________________________________________________________________________

Requested Readings
__________________________________________________________________________________
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Burial Wardrobe and Jewelry
__________________________________________________________________________________
__________________________________________________________________________________

Preferred Style/Material for:

Casket:____________________________________________________________________________

Burial Vault:________________________________________________________________________

Last Will and Testament:

Here is where you can find my will:
__________________________________________________________________________________
__________________________________________________________________________________

Executor:
__________________________________________________________________________________

Phone
__________________________________________________________________________________

Other Important Papers:
This list will help you locate documents necessary for settlement of my estate (birth certificate, marriage license, deeds, automobile titles, insurance policies, pension information, income tax records, banking records, bonds, securities, stock certificates, etc.)

Document/Location:
__________________________________________________________________________________
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Location of Safety Deposit Key:
__________________________________________________________________________________
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Obituary:
I've indicated here topics I would like included in my newspaper obituary:

Spouse:
__________________________________________________________________________________

Date/Place of Marriage:
__________________________________________________________________________________
__________________________________________________________________________________

Children:
__________________________________________________________________________________
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Other Survivors:
__________________________________________________________________________________
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My Address:
__________________________________________________________________________________
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Birth Date & Location:
__________________________________________________________________________________
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Education (schools & degrees):
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Military Service:
__________________________________________________________________________________
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Occupation:
__________________________________________________________________________________
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Achievements/Awards:
__________________________________________________________________________________
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Please also mention the following:
__________________________________________________________________________________
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Other Information:
The funeral director will need this when filling out my death certificate:

Date of Birth:
__________________________________________________________________________________

Place of Birth:
__________________________________________________________________________________

Social Security Number:
__________________________________________________________________________________

Usual Occupation:
__________________________________________________________________________________

Kind of Business/Industry:
__________________________________________________________________________________

Military Service:
__________________________________________________________________________________

Highest Level of Education Completed:
__________________________________________________________________________________

Father’s Name (first, middle, last):
__________________________________________________________________________________

Mother’s Name (first, middle, last, maiden):
__________________________________________________________________________________

Place of disposition (name of cemetery, crematory or other place):
__________________________________________________________________________________