INFORMATION NEEDED AT THE TIME OF DEATH

INFORMATION NEEDED AT THE TIME OF DEATH

· Inform family members of the existence and location of the document. File in an

accessible place at home, as well as in your church office, preferred funeral home,

and/or with a close family member or members.

Date of information ________________________________________________________

Family Information

Husband’s Name _________________________________________________________

Address ___________________________________________________________

Birthdate: Month/Day/Year _____________________________________________

Birthplace __________________________________________________________

(Death Date if applicable ______________________________________________)

Occupation _________________________________________________________

Date of Marriage _____________________________________________________

Place of Marriage ____________________________________________________

· Husband’s Father’s Name ____________________________________________

Father’s Place of Residence if surviving ___________________________________

(Father’s Death Date if applicable _______________________________________)

· Husband’s Mother’s Maiden Name ______________________________________

Mother’s Place of Residence if surviving ___________________________________

(Mother’s Death Date if applicable _______________________________________)

Wife’s Name (including maiden name) _________________________________________

Address ____________________________________________________________

Birthdate: Month/Day/Year ______________________________________________

Birthplace ___________________________________________________________

(Death Date if applicable _______________________________________________)

Occupation __________________________________________________________

· Wife’s Father’s Name _________________________________________________

Father’s Place of Residence if surviving ____________________________________

(Father’s Death Date if applicable ________________________________________)

· Wife’s Mother’s Maiden Name __________________________________________

Mother’s Place of Residence if surviving ____________________________________

(Mother’s Death Date if applicable ________________________________________)

Children (names, addresses, phone numbers, date of death if applicable)

____________________________________________________________________

Number of Grandchildren: ________________ Great Grandchildren: _________________

Brothers and Sisters (names, spouses, addresses, phone numbers, date of death if applicable)

____________________________________________________________________

Other Information

· List specifics about location of will, whom to notify, suggested charities for memorial

gifts, etc. on a separate page if necessary

Funeral Information for ______________________________________________________________________

Funeral Home preferred:

__________________________________________________________________________

Address and Phone Number:

_________________________________________________________________

Advance Plans? ___________________________________________________________________________

Suggested form of service filed? _________ If yes, where is it located?

____________________________________

If no form is filed, complete the information below:

Do you prefer burial? ________ Name of cemetery:

_____________________________________________________

Location of cemetery:

________________________________________________________________________

Burial Plot: Block _______________ Section ______________ Lot ________________ No. of graves _________

Lot Owner: _________________________________________ Phone No. _______________

If you have no burial plot, indicate cemetery of choice (name of cemetery and location):

__________________________________________________________________________

Cremation? ____________

If you prefer cremation, suggest disposal of ashes:

_________________________________________________

If you prefer organ or total body donation, please give specifics:

_________________________________________________________________________________________

SUGGESTIONS FOR FUNERAL/MEMORIAL SERVICE

Name of Minister(s) preferred (include contact information):

__________________________________________________________________________________________

Location for service (church or elsewhere):

__________________________________________________________________________________________

Suggested Organist (include contact information):

__________________________________________________________________________________________

Suggested Soloist or Choir or Musical Group (include contact information):

__________________________________________________________________________________________

Suggested Pall Bearers (include contact information):

__________________________________________________________________________________________

Honorary Pall Bearers (include contact information):

__________________________________________________________________________________________

Favorite Passages of Scripture: __________________________________________________________________

__________________________________________________________________________________________

Favorite Poems which might be read or excerpted (attach copies): _______________________________________

__________________________________________________________________________________________

Suggested Hymns or Solos (attach copies, especially if not well known): __________________________________

__________________________________________________________________________________________

Military Service? _________ If yes, prefer military ceremony? _______________

Special ceremonies at visitation such as Free Masons or Prayer Service? _________________________________

__________________________________________________________________________________________

Accomplishments and Honors during lifetime that should be mentioned in obituary or memorial service:

__________________________________________________________________________________________

Special Interests/Priorities you would want mentioned:

__________________________________________________________________________________________

Other Suggestions for your service that would be helpful to your family (donations in lieu of flowers; casket closed

during visitation or service; set maximum amount on expenses to aid family members making selections, etc.):

__________________________________________________________________________________________