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Funeral Plan Chart
My Funeral Plans
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Funeral Arrangements
[ ] My funeral arrangements have been pre-paid.
Arrangements have been made through:______________________________________________
______________________________________________
______________________________________________
______________________________________________
The documents and/or relevant details are located: ________________________________________
[ ] I have not pre-paid my funeral.
Physical Remains
Upon my death, I would like the following:
[ ] Donation of my organs
[ ] Any needed organs
[ ] Only the following:
[ ] Heart
[ ] Kidneys
[ ] Liver
[ ] Lungs
[ ] Pancreas
[ ] Corneas
I have completed an organ donor card. It can be found: ___________________________________
[ ] Donation of my body to(name of school or organization):________________________________
[ ] I would like my cremated remains returned to(family, partner, etc.):________________________
[ ] The school or organization may dispose of my remains
[ ] Cremation in a:
[ ] Traditional casket
[ ] Cardboard or similar casket made for the purpose
[ ] No casket
At my wake, funeral, or memorial service
[ ] I have no preference about a casket
[ ] I would like my casket to be:
__________________________________
__________________________________
__________________________________
__________________________________
[ ] Wake (viewing)
[ ] Open casket
[ ] Closed casket
To be held at: _______________________________________________
__________________________________________________________
[ ] Funeral service
[ ] Open casket
[ ] Closed casket
To be held at: _______________________________________________
__________________________________________________________
[ ] Direct burial or direct cremation without a wake or funeral service
[ ] Memorial service (body not present)
To be held at: _______________________________________________
__________________________________________________________
I would like to wear (i.e. a favorite suit, dress, uniform etc.)
__________________________________________________________
__________________________________________________________
I would like to be buried with (i.e. specific jewelry, religious item, teddy bear, etc.):
___________________________________________________________
___________________________________________________________
I would like:
[ ] Flowers
[ ] In lieu of flowers, donations to be made to:_________________________________
[ ] A religious service
[ ] A non-religious service
[ ] The following readings or prayers to be recited:
__________________________________________________________
__________________________________________________________
__________________________________________________________
[ ] I have no preference for readings or prayers
[ ] The following music to be played:
__________________________________________________________
__________________________________________________________
__________________________________________________________
[ ] I have no preference about the music at my wake, funeral or service
[ ] The following pallbearers:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
[ ] I have no preference about pall bearers
I would like to make the following special requests:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Obituary
I would like my obituary to include:
________________________________________________________________________
________________________________________________________________________
I would like my obituary to be placed in the following publications:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
[ ] I would like a photograph sent with my obituary
Resting Place
[ ] I do not own a cemetery plot or crypt, and would like to be buried at (city, state, locale, cemetery, family property, no preference, etc.):
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
[ ] own a cemetery plot or crypt at:
Name and location of cemetery:_______________________________________
________________________________________________________________
Plot number:______________________________________________________
Section:__________________________________________________________
Location of deed:___________________________________________________
I would like:
[ ] A grave marker
[ ] A grave stone
[ ] A monument
[ ] Other: _____________________________
____________________________________
[ ] None of the above
[ ] Maximum amount I want spent on this item is: $ ___________
[ ] With my ashes:
[ ] Scattered at (sea, family property, in the Catskills, etc?):
___________________________________________________________
By( family member, partner, etc.): _________________________________
[ ] Placed in an urn
[ ] Buried or entombed at: _________________________________
[ ] Given to: ____________________________________________
Funeral Coordinator
I would like the following individual(s) to be in charge of my final wishes:
___________________________________________________________
___________________________________________________________
Additional Wishes
___________________________________________________________
___________________________________________________________
___________________________________________________________
_____________________________________
Signature
_____________________________________
Print Name
Date: ________________________________
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