Name
My Address

Information about the person you are planning for:

Name
Legal Residence
MM slash DD slash YYYY
Spouse's Legal Name
MM slash DD slash YYYY
Mother's Legal Name
Father's Legal Name
Hispanic Origin?

Race

Work and Education:

Military Records (if no military, skip to next section)

MM slash DD slash YYYY
Copy of Discharge

Funeral or Memorial Service Preferences:

Address
Viewing for Family
Viewing for Friends

Person(s) to Finalize Arrangements at Time of Death

Name
Address

Special Instructions

I have appointed a Funeral Representative

For more info, see Funeral Rep in Resources Section

Disposition Options

Address

Memorials and Charities

Other Information and Special Instructions

Contact Options