Funeral Plan Chart

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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: ________________________________