For my loved ones I know this is a difficult time in numerous ways. It is my desire that you be spared additional worry and complications, so I have prepared these pages to assist you in planning and carrying out my closing matters. My last wishes include a list of people who should be notified of my passing, necessary arrangements, and financial and legal information for settling my estate. I hope that these directions ease the burden. I am grateful for these final favors you perform in my memory.
PERSONAL INFORMATION Name
First
Middle
Last
Maiden name
Social Security Number
Address
Street
City County
State/zip Phone
Birthplace
City State
Date of birth Country
Occupation_______________________________Date retired
Employer
Marital Status Married Single Divorced Widowed
Spouse’s Name
Father’s Name Birthplace
Mother’s Name Birthplace
If you are a Veteran, please complete this information:
Service Number Name of war
Branch Rank
Date Enlisted Date Discharged
Location of original discharge papers
Funeral Director
FUNERAL REQUESTS Participating Organizations (i.e., military or other)
FUNERAL REQUESTS Pallbearers
Special Service Requests
Favorite Hymns/Songs
Clothing to be worn
Flowers or Arrangements
Donations can be made to the following organizations
FUNERAL REQUESTS (CONT.) I expect expenses for a casket and Mortuary Service to total approximately
$___________________ and to consist of a:
I would prefer: Earth Burial Cremation/Inurnment
Mausoleum/Entombment
Plot already purchased
Other
Type of casket:
Cloth Covered Casket (moderate cost)
Metal Casket (average selection)
Metal Sealer Casket (finest protection)
Mortuary Service usually includes:
• Charges of first call at hospital or home
• Preservation and preparation
• Use of funeral coach/director
• Automobile for family and pallbearers
• Use of mortuary chapel for service and music
Cemetery
Name
Address
Phone
Flag: Folded Draped No flag
Presented to:
ANNOUNCEMENTS The following Publications/Newspapers should be notified:
Information to be contained in the Public Announcement
Spouse’s Name
If deceased, place and date of death
Family to be listed (brothers, sisters, children, etc.) Relationship
Education highlights
Date of Marriage
Religious, charitable, social, fraternal or lodge affiliations or special achievements you wish to mention
FAMILY INFORMATION FAMILY INFORMATION List children’s names (If married, list spouse’s name and grandchildren’s names)
LEGAL DOCUMENTS (LOCATION OF PAPERS AND DOCUMENTS)
Name of Estate Executor
Primary Decision Maker
Last Will and Testament
Durable POA for Health Care
Attorney Birth Certificate
Marriage Certificate
Certificates Bond Certificates Military Records
Passport Trust Fund Information Insurance Documents
Automobile Insurance Documents
Home Owners Insurance Documents
Mortgage Papers
Deed to House
Car Title or loans
Citizenship Papers (if applicable)
Income Tax Information
Passwords/PIN Numbers
Safe Deposit Box Location(s) and Persons with access to it
FINANCIAL INFORMATION (RECORD OF CHECKING/SAVINGS ACCOUNTS)
Checking Accounts
Institution
Account Number
Address
Institution
Account Number
Address
Savings Accounts
Institution
Account Number
Address
Institution
Account Number
Address
FINANCIAL INFORMATION (RECORD OF CREDIT CARD/IRA ACCOUNTS)
IRA, CDs, 401(k), or Additional Investments
Institution
Account Number
Address Institution Account Number
Address
Address
Institution
Institution Policy Number Agent
Beneficiary
Institution Policy Number Agent
Beneficiary
Institution Policy Number Agent
Beneficiary
Institution Policy Number Agent
Beneficiary
Record of other important documents Document Location
Document
Location
NOTIFICATION By providing the names and addresses of people who are significant in my life, I would like to ensure that these people will be notified of my death.
NOTIFICATION NOTIFICATION SPECIAL THOUGHTS I WOULD LIKE TO SHARE WITH MY FAMILY 
