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Funeral Information Form

Help With Funerals

Please feel free to cut and paste for your own records

Personal Wishes with Regard to Funeral or Memorial Service

Name: _________________________________________

Phone:____________________________

Address:_________________________________________________________________________

Date of Birth: __________________________Place of Birth:____________________

Social Security Number: _____________________ U.S. Veteran? Yes ___ No___

Spouse’s name: ________________________________

Children’s names:________________________________________________________

______________________________________________________________________

Father’s name: ________________________________ Place of Birth:____________________

Mother’s maiden name: ________________________ Place of Birth:____________________

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

It is my desire that the following wishes be honored by my family and friends in the event of my death, as circumstances permit, and with due consideration for their own desires. Arrangements for the service shall be made with the pastor of the church.

1. The type of service shall be:

_____ a Funeral ______ A Memorial Service: ________ at the Church __________ at the Mortuary

_____ A Private Burial Service (graveside) followed by a Memorial Service at the Church

_____ A Memorial Service followed by a Private Burial Service

_____ A Private Burial Service only (graveside)

_____ Other:

______________________________________________________________________________

2. The mortuary handling the details will be:__________________________________________________

at (address)________________________________________________________________________

.3. My cemetery preference is: __________________________, located at_______________________

I already own a lot located at:___________________________________________________________

4. Pertaining to the disposition of the body, it shall be:

____ Buried in the earth; or ______interred in a mausoleum

____ Cremated with disposition of the ashes:

_____________________________________________________

____ Needed organs are to be donated. Location of donor card :_____________________________

____ Bequeathed to ________________________________ Medical Facility for scientific research.

(Note: You must make these arrangements prior to death.)

5. The type and quality of the casket to be: _______ metal; ______ simple wood; ______ decorative wood

6. Lodge or Organization participation during service ________is desired. _________ is not desired

_____ Is desired but at an additional service at a time other than the Christian Service.

Name of Lodge or Organization: ______________________________________

7. I desire that the Service include:

Pastor:______________________________________________________________________

Assisting eulogist/ leader/pastor:________________________________________________________

Scripture selections:

____________________________________________________________________________________________

Poem or other relevant writing:

____________________________________________________________________________________________

Organ/Piano selections:

____________________________________________________________________________________________

Vocal selections:

____________________________________________________________________________________________

Congregational hymns:

____________________________________________________________________________________________

Additional:

____________________________________________________________________________________________

8. Memorial, Foundation, or Charity to which family and friends may contribute instead of flowers:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

9. Other requests or comments:

___________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Date: _________________ Signed:_______________________________________________________

Possible charges may be required for Church facilities, musicians, custodian and pastors.

Please complete, duplicate and sign three copies; keep one, file one with your Church and one with a responsible person. Do not keep your copy in a safe deposit box, but in a place known and accessible to members of your family. Additional copies of this form are available from the church office.

Whittier Presbyterian Church, 6030 El Rancho Dr., Whittier, CA 90606,

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