To relieve relatives and friends from burdens at the time of my passing,
I, [print name] __________________________________ would like:
Name of mortuary ______________
Autopsy [usually mandatory] Yes __________ No ________
Embalmed Yes ______________ No _________
Body to be viewed by family _______ by friends __________
Type of casket [not nec. when cremated in some states] ____________
Obituary in paper [withOUT address] ____________
Service: Yes _________ No _______ Priv ____ Public _____
Informal _______ Formal ______ By whom ______
Where _________ Passages to be read ________
Disposition of remains:
Donate to medical school ____
Buried in which cemetery ____ Type of vault __________
Cremated and put in wall ___ ground _____ on family
property ______ or scattered _____ at/over _______
Vital Statistics – for death certificate
Birth date and place ______________
Full name of father and place of birth ________________
Maiden name of mother and place of birth _______________
Social Security no. ______________________
Will updated on [date] ___________ It’s located at _________
Name and location of:
Cemetery plots ___________________
Life insurance co _________________ individual ____ group _____
Health insurance _____________ Homeowners insurance ________________
Car insurance _______________ Trusts _______________________
Powers of Attorney _______________ Combinations to safes ______________________
Partnerships ____________________ Contracts _____________________
Checking accounts ________________ Savings accounts _____________________
Credit cards ____________________ CD’s ___________________
Stocks _________________ Bonds _______________________
Mutual funds _____________________IRA _______________ Keogh _____________
Deeds ___________________ Mortgage cos. _____________________
Birth cert. _____________________ Lawyer _______________
Accountants ________________________ Brokers ______________________
Banks ____________________________ Safety deposit box __________________
Valuables __________________________ Military discharge ____________________
Other ________________________________________________
Date _______ Signature ______________________________________
This will ensure that you keep your readers happy.