<p> Information for Arranging My Funeral</p><p>Abiding Savior Lutheran Church</p><p>8211 Red Oak Drive</p><p>Mounds View, MN 55112</p><p>Telephone: 763-784-5120 Information for Arranging My Funeral</p><p>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.</p><p>Full Name: ______Date: ______/______/20_____</p><p>Home Address: ______Phone#: (_____)-_____-______</p><p>Email: ______Other: ______</p><p>I am a member of Abiding Savior Lutheran Church: Yes _____ No ______</p><p>DOCUMENTS</p><p>I have a prepared Health Care Directives document: Yes _____ No ______</p><p>I have a prepared estate/trust document/Power of Attorney: Yes _____ No_____</p><p>I have given copies of these documents to: ______</p><p>______</p><p>I have a will: Yes _____ No _____ Executor of my will: ______I am an organ donor: Yes ______No ______</p><p>Page 1</p><p>MY BIOGRAPHICAL INFORMATION </p><p>Full Name: ______Social Sec. # _____-____-______</p><p>Date of Birth: _____/____/_____ Birthplace ______</p><p>Father: ______Mother’s maiden name ______</p><p>Brothers and sisters’ names: ______</p><p>______</p><p>Childhood (spent in what city/state) ______</p><p>Educational history (high school, college, degrees earned): ______</p><p>______</p><p>Military service (when, where, how long, awards/honors): ______</p><p>______</p><p>Married (whom, when, where): ______</p><p>Children’s names: ______</p><p>______</p><p>Vocational (work) history (for whom, where, position): ______</p><p>______</p><p>Tributes/awards received, when retired: ______</p><p>Hobbies, sports, interests: ______</p><p>Clubs, societies, civic groups: ______</p><p>Church affiliation: ______Baptized (when and where): ______</p><p>Confirmed (when and where): ______Any additional facts: ______2</p><p>ARRANGEMENTS </p><p>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.</p><p>Company Name: ______</p><p>Address: ______</p><p>City ______State ______Zip Code ______</p><p>Phone: (_____)-_____-______Contact person: ______</p><p>Type of plan you have arranged: ______</p><p>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.): ______</p><p>______</p><p>If you have a burial plot provide the location: ______</p><p>______</p><p>Military burial: Yes _____ No ______Military ID# ______</p><p>MY WISHES ARE:</p><p>Autopsy: Yes _____ No _____ or may be decided by ______</p><p>Burial: Yes ____ No ____ Place: ______City: ______</p><p>State: ______Type of casket: ______My burial marker should read: ______</p><p>Cremation: Yes ____ No ____ I have an urn: Yes ______No ______</p><p>Cremation before or after the funeral service? Before _____ After ______3</p><p>MY WISHES (continued)</p><p>I want my ashes to be: Scattered ______Buried ______</p><p>Location: ______</p><p>Visitation: The evening before the funeral/memorial service ______</p><p>Just before the service ______</p><p>Both before the service and the evening prior to the service ______</p><p>No visitation</p><p>Viewing preferences: None _____ Immediate family only ______</p><p>Open casket _____ All family and friends ______</p><p>My favorite flowers: ______</p><p>Viewing/burial with special clothing, jewelry, etc.: ______</p><p>______</p><p>My favorite: Bible passages ______</p><p>Hymns/Songs ______</p><p>Prayers/Poems______</p><p>Other: ______After my death, final decisions concerning these funeral requests should be made by: ______</p><p>I have discussed these wishes with the following people:</p><p>Name ______Relationship ______Phone ______</p><p>Name ______Relationship ______Phone ______</p><p>Name ______Relationship______Phone ______</p><p>4</p><p>FUNERAL/MEMORIAL SERVICE INFORMATION</p><p>What type of service: _____Funeral ( a service where the body is present)</p><p>_____Memorial ( a service where no body is present)</p><p>Note: Either type of serice is acceptable in the Christian Faith</p><p>Where do you prefer the service to be held: Church _____ Funeral Home _____</p><p>Name/Location (address): ______</p><p>Clergy/person to officiate, if possible: ______</p><p>Pallbearers (if applicable): ______</p><p>______</p><p>Organist: Church Provided ______Other ______</p><p>Soloist(s): None _____ Name(s) ______</p><p>Do you want a eulogy to be given (i.e. a summary of your life/legacy):</p><p>Yes ____ No ____ If yes, by whom: ______</p><p>Biblical text preferences; ______</p><p>Hymns or other music preferences: ______</p><p>______</p><p>Organizations participating (fraternal, clubs, etc.): ______</p><p>______</p><p>Committal Service: At graveside? Yes _____ No _____</p><p>At disposal of ashes? Yes _____ No _____</p><p>Other: ______5</p><p>Funeral/Memorial Service (continued)</p><p>I want memorial gifts designated to the following organization(s), persons etc:</p><p>Name ______Address ______</p><p>Name ______Address ______</p><p>Name ______Address ______</p><p>Any requests concerning the small biographical leaflet typically provided by the funeral home: ______</p><p>Other instructions (e.g. bulletin cover for service): ______</p><p>______</p><p>______My Signature: ______Date: ______6</p><p>Jesus said to him, “I am the way and the truth, and the life.” John 14:6 </p>