Abiding Savior Lutheran Church

Information for Arranging My Funeral

8211 Red Oak Drive

Mounds View, MN 55112

Telephone: 763-784-5120 Information for Arranging My Funeral

This form is to inform your loved ones of your wishes when you die. Planning for one’s death is not something most of us look forward to doing, but it will greatly help your family and loved ones who will handle your final affairs during a time of stress. Taking time today to thoughtfully complete this form can provide peace of mind to yourself and your family. Please discuss these wishes with your loved ones, make copies of your completed form, and give them to individuals who will be involved with your funeral, e.g. family, close friends, pastor, funeral director, etc.

Full Name: ______Date: ______/______/20_____

Home Address: ______Phone#: (_____)-_____-______

Email: ______Other: ______

I am a member of Abiding Savior Lutheran Church: Yes _____ No ______

DOCUMENTS

I have a prepared Health Care Directives document: Yes _____ No ______

I have a prepared estate/trust document/Power of Attorney: Yes _____ No_____

I have given copies of these documents to: ______

______

I have a will: Yes _____ No _____ Executor of my will: ______I am an organ donor: Yes ______No ______

Page 1

MY BIOGRAPHICAL INFORMATION

Full Name: ______Social Sec. # _____-____-______

Date of Birth: _____/____/_____ Birthplace ______

Father: ______Mother’s maiden name ______

Brothers and sisters’ names: ______

______

Childhood (spent in what city/state) ______

Educational history (high school, college, degrees earned): ______

______

Military service (when, where, how long, awards/honors): ______

______

Married (whom, when, where): ______

Children’s names: ______

______

Vocational (work) history (for whom, where, position): ______

______

Tributes/awards received, when retired: ______

Hobbies, sports, interests: ______

Clubs, societies, civic groups: ______

Church affiliation: ______Baptized (when and where): ______

Confirmed (when and where): ______Any additional facts: ______2

ARRANGEMENTS

Have you made pre-planning arrangements with a mortuary, crematory, or cemetery? If so, fill out the following information. If not, proceed to the “My Wishes Are” section below.

Company Name: ______

Address: ______

City ______State ______Zip Code ______

Phone: (_____)-_____-______Contact person: ______

Type of plan you have arranged: ______

Have you paid in advance or purchased insurance to cover the costs of your funeral arrangements? Yes ______No _____ If yes, please specify type of arrangements (contract or policy numbers, etc.): ______

______

If you have a burial plot provide the location: ______

______

Military burial: Yes _____ No ______Military ID# ______

MY WISHES ARE:

Autopsy: Yes _____ No _____ or may be decided by ______

Burial: Yes ____ No ____ Place: ______City: ______

State: ______Type of casket: ______My burial marker should read: ______

Cremation: Yes ____ No ____ I have an urn: Yes ______No ______

Cremation before or after the funeral service? Before _____ After ______3

MY WISHES (continued)

I want my ashes to be: Scattered ______Buried ______

Location: ______

Visitation: The evening before the funeral/memorial service ______

Just before the service ______

Both before the service and the evening prior to the service ______

No visitation

Viewing preferences: None _____ Immediate family only ______

Open casket _____ All family and friends ______

My favorite flowers: ______

Viewing/burial with special clothing, jewelry, etc.: ______

______

My favorite: Bible passages ______

Hymns/Songs ______

Prayers/Poems______

Other: ______After my death, final decisions concerning these funeral requests should be made by: ______

I have discussed these wishes with the following people:

Name ______Relationship ______Phone ______

Name ______Relationship______Phone ______

FUNERAL/MEMORIAL SERVICE INFORMATION

What type of service: _____Funeral ( a service where the body is present)

_____Memorial ( a service where no body is present)

Note: Either type of serice is acceptable in the Christian Faith

Where do you prefer the service to be held: Church _____ Funeral Home _____

Name/Location (address): ______

Clergy/person to officiate, if possible: ______

Pallbearers (if applicable): ______

______

Organist: Church Provided ______Other ______

Soloist(s): None _____ Name(s) ______

Do you want a eulogy to be given (i.e. a summary of your life/legacy):

Yes ____ No ____ If yes, by whom: ______

Biblical text preferences; ______

Hymns or other music preferences: ______

______

Organizations participating (fraternal, clubs, etc.): ______

______

Committal Service: At graveside? Yes _____ No _____

At disposal of ashes? Yes _____ No _____

Other: ______5

Funeral/Memorial Service (continued)

I want memorial gifts designated to the following organization(s), persons etc:

Name ______Address ______

Any requests concerning the small biographical leaflet typically provided by the funeral home: ______

Other instructions (e.g. bulletin cover for service): ______

______

______My Signature: ______Date: ______6

Jesus said to him, “I am the way and the truth, and the life.” John 14:6