A Personal Planning Guide
Obituary Guide
Nothing you can lose by dying is half so precious as the readiness to die, which is man’s charter of nobility.
GEORGE SANTAYANA
TO MY LOVED ONES,
I have recorded the information contained in my personal planning guide for your peace of mind as well as my own. I sincerely hope it will spare everyone unnecessary grief, distress and expense at the time of my death. It means a great deal to me to know that I have taken the steps to eliminate as much as possible the burden of decision-making in this matter
I have tried to complete this information whish much love and thought, knowing that it might cause greater distress if these decisions were left for you to make with no indication of my wishes.
I sincerely hope you will find these arrangements in accordance with your own wishes. It is my most sincere intention that this information will ease the burden as much as possible
__________________________________________
Signature Date
PERSONAL INFORMATION
This section provides your loved one with personal information on you…. information perhaps only known by you. Without this information, your loved ones will no be bale to file important and necessary papers upon your death. Having this information readily available for you loved ones eases stress during an already emotional time.
Full Legal Name: _________________________________________________________
First Middle Last
Street Address: ___________________________________________________________
City:_____________________________ State and Zip Code: ______________________
Date of Birth: ______________________ Place of Birth: _________________________
Social Security Number: ______________________ Citizenship: __________________
Length of residency: ______________________________________________________
Occupation: _____________________________________________________________
Employer: ___________________________ Date Retired: ________________________
Type of Business ______________________ No. Years employed: _________________
Mother’s maiden name: ____________________________________________________
Her place of birth: ________________________________________________________
Father’s name: ___________________________________________________________
His place of birth: _________________________________________________________
EDUCATION
High school __________________________________________________
Name State
College __________________________________________________
Name State
Graduate School __________________________________________________
Name State
MARITAL STATUS
q Married Spouse’s Name _______________________
q Single
q Divorced
q Widowed
MILITARY INFORMATION
Dates of service __________________________________________________
Branch of service and rank__________________________________________________
Service number __________________________________________________
Wars/Conflicts served __________________________________________________
UPON MY DEATH PLEASE NOTIFY
Name: __________________________________________________________________
First Middle Last
Street Address: ___________________________________________________________
City:_____________________________ State and Zip Code: ______________________
Telephone Number: (______)_______________________________________________
Relationship: ____________________________________________________________
PERSONAL INFORMATION ABOUT MY LOVED ONES
During the emotional time following your death, your survivors will find this information helpful in preparing an accurate obituary.
Spouse: ______________________________________________________ □ Deceased
Place and Date of spouse’s death: ____________________________________________
Wedding Date: ___________________________________________________________
Children
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Siblings
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: ___________________________________________________ □ Deceased
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
The best portion of a good man’s life, His little, nameless, unremembered acts of kindness and of love
WILLIAM WORDSWORTH
PERSONAL FRIENDS AND RELATIVES
You may have friends and relatives you would like to have contacted at the time of your death. By including their names here they will not be over looked.
Name: _____________________________________________________________
Relationship: ________________________________________________________
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: _____________________________________________________________
Relationship: ________________________________________________________
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: _____________________________________________________________
Relationship: ________________________________________________________
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: _____________________________________________________________
Relationship: ________________________________________________________
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
Name: _____________________________________________________________
Relationship: ________________________________________________________
City and State _______________________________________________________
Telephone Number: (______)___________________________________________
With out friends no one would choose to live, though he had all other goods. ARISTOTLE
PERSONAL WISHES
The details of your final arrangements can be handled with ease and assurance by providing your loved ones with this information. They will be reassured that the decisions they are making honor the life you lived and fulfilled your last wishes.
Memorial Instructions: Please contact the funeral home listed below to conduct my
final arrangements.
Funeral home: ____________________________________________________
Address: ________________________________________________________
Telephone Number: (______)________________________________________
To eliminate burden and hardship for my loved ones I have:
Prearranged my funeral Prefunded my funeral
Viewing /Visitation Yes No
Open Casket Closed Casket
Location of Ceremony Funeral Home Graveside
Church Other ________________
Church Preference: ________________________________
Clergy desired: ___________________________________
Type of Ceremony Traditional Graveside
Cremation Immediate burial
Other ________________________________________
Special Ceremony Lodge rites Military
Fraternal Other ________________
Type of Casket/urn Wood Metal
Type of vault Concrete Steel
Other ________________________________________
Floral request: ___________________________________________________________
Memorial Contributions: ___________________________________________________
Music: _________________________________________________________________
Pall Bearers: ___________________________________________________________
Name
___________________________________________________________
Name
_______________________________________________________
Name
___________________________________________________________
Name
___________________________________________________________
Name
___________________________________________________________
Name
Clothing Mine Purchase New Clothes
Jewelry Remove Leave on
Newspaper Notice Yes No
Cemetery _______________________________________________________________
Telephone Number: (______)________________________________________________
Lot Description Lot no. _____________ Space no. ___________ Section _______
Deed owner/location ______________________________________________________
Interment Burial Cremation
Mausoleum Scattering
Lawn crypt Ground burial
Niche/Columbarium Other ________________
Type of memorial Companion Individual
PERSONAL PAPERS, DOCUMENTS AND INSURANCE INFORMATION
This section can help your survivor’s tremendously by telling them where everything is kept. This eliminates a search and gives your loved ones the peace of mind knowing that nothing has been missed.
Important Document Locations
Birth/Death Certificates: ________________________________________________
Children’s birth certificates: ________________________________________________
Marriage certificates: ________________________________________________
Deeds and titles: ________________________________________________
Mortgages and notes: ________________________________________________
Automobile records/titles/registrations
________________________________________________
Income tax records/W-2′s ________________________________________________
Veteran discharge papers ________________________________________________
Bank Accounts ________________________________________________
Name of bank Account Number Type of Account
________________________________________________
Name of bank Account Number Type of Account
________________________________________________
Name of bank Account Number Type of Account
________________________________________________
Name of bank Account Number Type of Account
Safety Deposit Box: ________________________________________________
Location
________________________________________________
Location of keys for above
Safe combination ________________________________________________
Credit Cards ________________________________________________
Account Number
________________________________________________
Account Number
________________________________________________
Account Number
Will: ___________________________________________________________________
Attorney: ________________________________________________
Name Telephone Number
Location: ________________________________________________
City State Zip
The executor of my Will is ________________________________________________
Name Telephone Number
To obtain a Living Will and Medical power of attorney you may contact your local attorney, or state medical board or Choice in Dying at 1-800-989-9455
Living Will: Yes No
______________________________________________
City State Zip
Medical Power of Attorney Yes No
______________________________________________
City State Zip
The person designated under my medical power of attorney is
_______________________________________________
Name Telephone Number
Insurance Information: I have purchased the following insurance policies.
Company ____________________________________________
Telephone number (_______)_____________________________
Policy number ____________________ Amount $____________
Reason Purchased: ______________________________________
Company ____________________________________________
Telephone number (_______)_____________________________
Policy number ____________________ Amount $____________
Reason Purchased: ______________________________________
Give us the strength to encounter that which is to come
– ROBERT LOUIS STEVENSON
PERSONAL SURVIVOR BENEFITS
Your loved ones may be eligible for government benefits from Social Security and/or the Veteran’s Administration. Your funeral director may be helpful in coordinating these benefits.
Social Security Benefits For current information, specific benefits and claims procedures, contact the National Social Security office at 1-800-772-1213 or your local office at:
City/State _______________________________________
Telephone number (______)_________________________
To facilitate receiving Social Security benefits,* your survivors will need:
1. A copy of the Death Certificate
2. Social Security Number
3. Marriage Certificate
4. Children’s Birth Certificate(s)
5. Proof of Widow(er)’s age is 62 or older
6. Preceding year’s W-2 Form or Schedule “C”
* Social Security may also pay a one-time lump sum death benefit.
Veteran’s Benefits Your funeral director should have a copy of your Veteran discharge papers, as a Veteran is generally entitled to the following burial benefits; a burial flag and a headstone or grave marker. If your papers arte lost, contact the Department of Veteran’s Administration at 1-800-827-1000 or your local office at:
City/State _______________________________________
Telephone number (______)_________________________
When your survivors contact the Veteran’s Administration office for survival and/or burial benefits, the following will be required:
1. Service separation papers
2. Social Security Number
3. Marriage Certificate
4. Proof of Termination of Marriage
5. Children’s Birth Certificate(s)
PERSONAL REMARKS
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