INFORMATION AND INSTRUCTIONS ON FINAL AFFAIRS
Name ________________________ Date ________
Address ________________________ Soc. Sec. No. ________________
I request that the Religious Society of Friends carry out the following upon my death:
The information below may help those responsible carry out my wishes:
1. Persons to notify at once: (next of kin, co-workers, executor, &c.)
Name ________________________ Name ________________________
Address ________________________ Address ________________________
Telephone ________________ Telephone ________________
Relationship ________ Relationship ________
2. Member of memorial society:
Address ________________________ Telephone ________
3. Disposal of body: burial __ cremation __ medical research __ organ donations __
Disposal of ashes ________________
Cemetery preferred ________ Common plot ________
Location of deed ________________ Family plot ________
Location of release papers ________________________
Undertaker preferred ________________
4. Burial insurance: Insurance company ________________
policy number ________________
If no insurance, expenses to be met as follows: ________________________________
5. Memorial meeting for worship desired? ________
Special requests: ________________________
6. Flowers accepted ________ Where ________________
In lieu of flowers, contributions may be made to: ________________________
7. Special instructions if death is distant from home: (over)
8. My will is located at ________________________
________________________________________
9. If no surviving parents, instructions on care of minor children: (over)
10. Information for death certificate (must agree with legal records and policies):
Full legal name ________________________
Present address ________________________
Birth date ________ Birth place ________________ Citizenship ________________
Occupation ________________ Present employer ________________
Job title ________________ Address ________________________
Father's full name ________________________
Mother's full name ________________________
11. My signature to this document ________________________
Received for the monthly meeting: date ________________________________
(clerk's or recorder's signature)
________________________ Monthly Meeting
(print monthly meeting name)
Address ________________________
The New York Yearly Meeting of the Religious Society of Friends