This check list is intended for your personal
use. It is designed to help you gather important information and to help guide you
through the process of making decisions about your funeral. You can print the check
list and complete it at your convenience. Share your wishes with a family member
or trusted friend. If you do not want to review the check list with a family member,
at least let someone know where it can be located in the event of your death.
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.
___________________________________
___________________________________
___________________________________
____
I have a Living Will (location)
___________________________________
___________________________________
Notification:
Please
let all these people know of my death:
Spouse (telephone number)
___________________________________
Children
(full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Parents
(names and telephone numbers)
___________________________________
___________________________________
___________________________________
Siblings
(full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
Friends
(full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Business
Associates (names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
Place
of Worship (include telephone number)
___________________________________
___________________________________
This
is who I want to handle my funeral:
Funeral Director: ______________________________
Funeral
Home: ______________________________
Address: ______________________________
______________________________
______________________________
Please
ask these loved ones to be my pallbearers:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Details
of my funeral:
Speaker
Location of Funeral
Location of Burial
I
prefer:
____ Flowers
____ Tributes to (charity or organization)
____________________________________________
____________________________________________
____________________________________________
Favorite Music
____________________________________________
____________________________________________
Requested
Readings
____________________________________________
____________________________________________
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
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Location
of Safety Deposit Key:
____________________________________________
____________________________________________
Obituary:
I've
indicated here topics I would like included in my newspaper obituary:
Spouse
____________________________________________
Date/Place
of Marriage
____________________________________________
____________________________________________
Children
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Other
Survivors
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
My
Address
____________________________________________
____________________________________________
Birth
Date & Location
____________________________________________
____________________________________________
Education
(schools & degrees)
____________________________________________
____________________________________________
____________________________________________
Military
Service
____________________________________________
____________________________________________
Occupation
____________________________________________
____________________________________________
Achievements/Awards
____________________________________________
____________________________________________
Please
also mention the following:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
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)
____________________________________________