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Funeral Plan Chart

My Funeral Plans

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Funeral Arrangements

[  ] My funeral arrangements have been pre-paid.

Arrangements have been made through:______________________________________________

______________________________________________

______________________________________________

______________________________________________

The documents and/or relevant details are located: ________________________________________

[  ] I have not pre-paid my funeral.


Physical Remains

Upon my death, I would like the following:

[  ] Donation of my organs

[  ]  Any needed organs

[  ] Only the following:

[  ] Heart

[  ] Kidneys

[  ]  Liver

[  ] Lungs

[  ] Pancreas

[  ]  Corneas

I have completed an organ donor card. It can be found: ___________________________________

[  ] Donation of my body to(name of school or organization):________________________________

[  ] I would like my cremated remains returned to(family, partner, etc.):________________________

[  ] The school or organization may dispose of my remains

[  ] Cremation in a:

[  ] Traditional casket

[  ] Cardboard or similar casket made for the purpose

[  ]  No casket

At my wake, funeral, or memorial service

[  ]  I have no preference about a casket

[  ]  I would like my casket to be:

__________________________________

__________________________________

__________________________________

__________________________________


[  ]  Wake (viewing)

[  ] Open casket

[  ]  Closed casket

To be held at: _______________________________________________

__________________________________________________________


[  ] Funeral service

[  ]  Open casket

[  ] Closed casket

To be held at: _______________________________________________

__________________________________________________________


[  ] Direct burial or direct cremation without a wake or funeral service

[  ] Memorial service (body not present)

To be held at: _______________________________________________

__________________________________________________________


I would like to wear (i.e. a favorite suit, dress, uniform etc.)

__________________________________________________________

__________________________________________________________


I would like to be buried with (i.e. specific jewelry, religious item, teddy bear, etc.):

___________________________________________________________

___________________________________________________________


I would like:

[  ] Flowers

[  ] In lieu of flowers, donations to be made to:_________________________________


[  ] A religious service

[  ]  A non-religious service

[  ] The following readings or prayers to be recited:

__________________________________________________________

__________________________________________________________

__________________________________________________________

[  ] I have no preference for readings or prayers

[  ] The following music to be played:

__________________________________________________________

__________________________________________________________

__________________________________________________________

[  ]  I have no preference about the music at my wake, funeral or service

[  ] The following pallbearers:

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________

[  ]  I have no preference about pall bearers

I would like to make the following special requests:


________________________________________________________________________

________________________________________________________________________

________________________________________________________________________


Obituary

I would like my obituary to include:

________________________________________________________________________

________________________________________________________________________


I would like my obituary to be placed in the following publications:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

[  ] I would like a photograph sent with my obituary

Resting Place

[  ]  I do not own a cemetery plot or crypt, and would like to be buried at (city, state, locale, cemetery, family property, no preference, etc.):

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

[  ]  own a cemetery plot or crypt at:

Name and location of cemetery:_______________________________________

________________________________________________________________

Plot number:______________________________________________________

Section:__________________________________________________________

Location of deed:___________________________________________________

I would like:

[  ]  A grave marker

[  ]  A grave stone

[  ] A monument

[  ]  Other: _____________________________

____________________________________

[  ]  None of the above

[  ] Maximum amount I want spent on this item is: $ ___________

[  ]  With my ashes:

[  ]  Scattered at (sea, family property, in the Catskills, etc?):

___________________________________________________________

By( family member, partner, etc.): _________________________________

[  ] Placed in an urn

[  ] Buried or entombed at: _________________________________

[  ] Given to: ____________________________________________

Funeral Coordinator

I would like the following individual(s) to be in charge of my final wishes:

___________________________________________________________

___________________________________________________________

 

Additional Wishes

___________________________________________________________

___________________________________________________________

___________________________________________________________

 

_____________________________________

Signature

_____________________________________

Print Name

Date: ________________________________

 


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