PERSONAL PLANNING SHEET FOR

(Name)

General Information
Street Address Date of Birth
A City, ST Zip Emergency Contact(s)
Phone

Veteran Branch and Dates of Service

B
(If checked, Contact Regional Veterans Affairs)

Pre-arrangements Advance Directives

Have been made Living will / medical power-of-attorney
Need to be made Need Developed

C Can be made when needed according to this plan In effect

Funeral Home Designated agent(s)
Phone Location of Document
Contact Desire Home / Hospice Care

Preferences and Arrangements

Obituary Notes:

Services Select any and all options that denote your preferences
None Religious Affiliation, if any
Private Public
Graveside Only Eucharist / Last Rites Rosary
Visitation Viewing
Funeral Celebration of Life Mass of Christian Burial
LOCATION: Church Synagogue Other Location

Preferred Officiant (Name & Title)

Name of Location
E Street Address
City, ST Zip
Phone ( ) —

Clothing to be dressed in:

Other specific details:

Music Songs
None Instrumental
Vocalist
Congregational Singing

Print Name Signature Date Page

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PERSONAL PLANNING SHEET FOR
(Name)
Services (Cont'd)

Scripture Verses

Inspirational
poems, quotes
or thoughts

E Flowers Type(s) Color (s)

None

Reception Wake Other

Name of Location
Street Address
City, ST Zip Phone ( ) —

Final Disposition Preferences (See Section G for Disposition Location)

Burial
NO Burial
Casket Preferences
Wood Fiberglass Other
Metal Plastic
Color / Liner Preferences:

Cremation
NO Cremation
Container Preferences (wood, ceramic, color, etc.)
Urn
Box
F
Disposition Preferences
Burial Vault Dispersed
(Note: See Section G for specifics of location or other handling.)

Donation

NO Donation Specify all or some, note your preferences

Registered as an organ donor Kidney Eyes Heart Lungs Liver
MVD designation Pancreas Skin Grafts Intestinal Tissue
Permission to register on donor list
Donation to Science / Education
Specific school

Specific program

Print Name Signature Date Page

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PERSONAL PLANNING SHEET FOR
(Name)
Final Disposition Location

Desired Location (City, State)

Cemetery desired
Already purchased Need to purchase
Single Plot
Double Plot adjoining:
Single Vault
Double Vault adjoining

Headstone / Marker / Monument Single Double

G Already purchased Need to purchase
Color / Stone type

Insignia / symbols / images

Inscription Preferences

Ashes Dispersed By Whom

Location(s)

Additional Instructions & Comments Regarding Arrangements & Preferences

Property & Affairs Note: This does not replace legal documents; legal documentation is strongly recommended.

Estate Trust Executor(s) or Estate Representative(s) designation

Legal document location(s)

I
Will
Other
Location of documents regarding disposition of personal property and effects

My Message to Loved Ones (How I hope to be remembered / My legacy / You must go on)

Print Name Signature Date Page

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