FUNERAL INSTRUCTIONS FOR ____________________

FUNERAL INSTRUCTIONS FOR _____________________

To assist those responsible for my funeral arrangements, I make the following suggestions:

1. I wish to have my service held at:

�� (� �) My church, which is _____________________��

�� (�� ) The funeral home
�� (� �) My own home

�� (�� )� __________________________________________

2. Contact _____________________ (church/ synagogue) immediately in order that my clergyman __________________________________ may offer assistance to my family.

3. I suggest that the following funeral home be called:_______________________________________

4. I desire that there be:

�� (�� )� Private service limited to family and close friends

�� (�� )� Public service.

�� (�� )� Disposal of body as soon as legally possible

�� (�� )� Closed casket�� (�� )� Open casket

�� (�� )� Inexpensive casket �(�� )� Elaborate casket.

�� (�� )� No visiting hours and no display of body

�� (�� )� Obituary notice at time of death

�� (�� )� Obituary notice prior to memorial service

�� (� �) �No obituary notices

5. I wish to have the following:

�� (�� )� Usual funeral with graveside service

�� (�� )� Memorial service with private burial before or after

�� (�� )� My body cremated (with service as in�dicated above)

�6. I would prefer that instead of sending flowers my friends make memorial gifts, if they wish, to �� __________________________________________

7. I make the following suggestions of material which I would like to have used in my service:

�� Scripture passages: __________________________________________

�� Favorite appropriate poem: __________________________________________

�� Prayers: __________________________________________

�� Music: __________________________________________

�� Other: __________________________________________

8. I desire that my body be

�� (�� ) Buried in �(�� ) �Cemetery
�� (�� ) Cremated and my ashes be:

�� (�� ) Buried in _____________________ cemetery
�� (�� ) Placed in a columbarioum in_____________________

�� (�� ) Disposed of as follows: __________________________________________

�� (�� ) Donated to_____________________ Medical School for anatomical studies as per previous arrangement (a copy of which is in my personal files).

9. (�� ) I would like to donate my eyes to the New England Eye Bank (form completed in advance and on file in their office).

10 Vital Statistics .

�� Date of Birth: _____________________��

�� Place of Birth: _____________________

�� Church Membership: _____________________

�� Occupation: _____________________

�� Social Security Number: _____________________ ��

�� If veteran, branch, rank, dates, serial no.:__________________________________

11. To be Contacted:

�� (�� ) Next of Kin: __________________________________________

�� (�� ) Friends: __________________________________________

�� _______________________________________________________________

�� (�� ) Physician: __________________________________________

�� (�� ) Attorney: __________________________________________