Your Full Name
Your Email Address
Your Maiden Name
Street/Mailing Address
City
State
Zip Code
Date of Birth
Place of Birth
Social Security Number
Spouse's Name
Spouse Survived?
Yes
No
Marital Status
Date of Marriage
Place of Marriage
Names of Previous Spouses
Names of Parents
Address of Parents (if still living)
Names of Children
Addresses and Phone numbers of Children
Names of Brothers and Sisters
Addresses and Phone numbers of Brothers and Sisters
Names of other friends and relatives who should be notified
Addresses and Phone numbers of other friends and relatives
Occupation
Names of present and previous employers
Addresses and Phone numbers of present and previous employers
If you are a veteran
Date of enlistment
Place of enlistment
Date of discharge
Place of discharge
Rank
Service Numbers
Organization or outfit
Commendations received
Location of discharge papers
Flag desired to drape casket
Religious affiliation
Professional and fraternal organization memberships
Education (list schools attended and dates of any degrees or honors received):
Names of newspapers for obituary
Organ Donation (list of authorized card and anyone who should be notified)
Funeral director or funeral home you prefer
Clergyperson or anyone else you would like to officiate
Funeral Service Location
Visitation instructions
Music, hymns or readings you would prefer during your service
Memorial Donations you would like in your memory
Names and Addresses and Phone Numbers of casket bearers
Cemetery Name
Address and location of cemetery property (include lot and grave number)
Casket and/or vault preference
If you wish to be cremated, include disposition preference
Location of will
The name of the executor of your estate
Address and phone number of the executor of your estate
Location of safety deposit box and key
Attorney's name
Attorney's address and phone number
Location of checking accounts, checkbooks, savings accounts and passbooks
Credit cards and charge accounts to be canceled.
(For security purposes do not list Credit Card Numbers here, just the names of cards.)
Insurance company name and policy numbers
Location of insurance policies
Any additional instructions