Personal Preplanning Funeral Form

Does your family know of your last wishes? If not, you may wish to address the following. Please

note that this is not a legal document, but a record to convey your final wishes. One copy should be

given to family or friend and one copy to the church.

1. Name(s) of preferred individuals(s) to assist in arrangements (relative, friend, pastor, attorney):

Name: ____________________Address: _______________________Phone: _______________

Name: ____________________Address: _______________________Phone: _______________

Name: ____________________Address: _______________________Phone: _______________

Please check the following if it is your desire

5. Funeral home, Funeral, Memorial Service

___ That a ___ public ___ private funeral be held at ___ church ___ funeral home

arrangements and cost (limit)

___ That a memorial service (i.e. body not being present) be held at __________________

___ That neither a funeral nor memorial service be held

6. Final disposition

___ That my ashes be preserved or disposed of in the following manner and

place:______________________________________________________

___ That my body be buried in the following location

___ It is my wish to donate whatever organs/parts of organs that are useful to the living

7. Contributions/Flowers

___ Flowers are desired

___ Organizations to which contributions may be sent

I understand that these are my instructions to my family and friends. I recognize my own

responsibility for advance consultation with the minister or mortician of my choice.

Signed:_______________________________________

Witness (preferably next of kin): ______________________________________