W T E A

WHAT TO EXPECT WHEN A DEATH OCCURS
Please accept our sympathy and support at this most difficult time. We thank you for the confidence you have
placed in us. Realizing this may be your first experience with the death of a loved one, we are committed to:


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Personally guiding and directing you through the funeral process with caring, professional service
Educating you on the many options available to you in making this final tribute personal and
meaningful
Being available to you after the funeral to assist in any way we can
One of our Funeral Directors will be calling you for an arrangement interview. To best serve you, please allow
two hours for this appointment.
We encourage you to read through the following information prior to meeting with them. It will prepare you
for the many decisions you will be making in the funeral planning process.
Although you may not feel it now, the death of a loved one impacts you mentally, physically, emotionally,
socially and spiritually. The funeral service embraces you in every aspect. We encourage you to utilize and
participate in the therapeutic value of the service.

MENTALLY - Planning the funeral and viewing the body allows you to believe the death has occurred.
You begin to realize how dramatically your life has changed.

PHYSICALLY - The funeral process provides you with order and structure during the initial periods of
numbness and confusion.

EMOTIONALLY - It allows an open expression of your love and grief through memory sharing and
having the opportunity to say good-bye or anything that has been left unsaid.

SOCIALLY - Family and friends will come to support you as well as give testimony to the meaningful
relationship they had with your loved one. You come together to share the love and the loss.

SPIRITUALLY - Expressing your religious beliefs through the funeral process allows you to be grounded
in your faith which may be your source of strength and comfort in the days to come.
~4~
THINGS TO CONSIDER
It will be necessary for you to meet with the Funeral Director prior to finalizing any plans or arrangements.
They will coordinate your requested service time, subsequent to funeral home’s scheduling.
SERVICE SECTION AND OPTIONS:
o
o
o
o
o
o
o
o
o
o
Total Service - Chapel or Church Service
Customized Service- At Home, Civic Club, Park, Garden, etc.
Graveside
Direct Interment
Out of Town Transfer
Vault Selection, Casket Selection
Visitation - Casket Open/Closed
Music, Memory Board, Memory Table, Flowers
Minister - We can assist in selecting a minister upon request
Pallbearers - Six (6) pallbearers are typically selected from family and friends, but we can assist upon
request
BURIAL COSTS AT THE CEMETERY:
o
o
o
Grave Space, Lawn Crypt, or Mausoleum
Marker / Headstone
Opening and Closing Fee
 A Veteran, honorably discharged from the Armed Forces, is entitled to a free burial in a National
Cemetery. The government provides the ground space, use of a grave liner, GI veterans marker,
opening and closing costs and shelter for the committal service for the veteran and their immediate
spouse. The Funeral Director will make these arrangements on behalf of the family.
 Veterans Gardens are available at most local cemeteries offered at the family’s expense. It is
important that you discuss the need of convenience and frequency in visiting the grave before
committing to a burial in a National Cemetery.
 The next page goes into further detail for Veteran Benefits.
CREMATION:
o
o
o
o
o
o
Total Cremation Funeral Service
Loved one present and casketed
 (We require embalming for a public viewing)
Memorial Service
Option of urn present or simply a memory display
Basic Cremation
No service arranged by the Funeral Home
MEMORIALIZATION OPTIONS AT THE CEMETERY:
(Permanent placement of Cremated Remains)
Discuss options available to you with the Funeral Director.
~5~
VETERANS BENEFIT INFORMATION
BURIAL IN A NATIONAL CEMETERY
Burial benefits available include a gravesite in any of our 128 national cemeteries with available space, opening and
closing of the grave, perpetual care, a Government headstone or marker, a burial flag, and a Presidential Memorial
Certificate, at no cost to the family. Some veterans may also be eligible for Burial Allowances. Cremated remains are
buried or inurned in national cemeteries in the same manner and with the same honors as casketed remains.
Burial benefits available for spouses and dependents buried in a national cemetery include burial with the veteran,
perpetual care, and the spouse or dependents name and date of birth and death will be inscribed on the veteran’s
headstone, at no cost to the family. Eligible spouses and dependents may be buried, even if they predecease the
veteran.
BURIAL IN A PRIVATE CEMETERY
Burial benefits available for veterans buried in a private cemetery include a Government headstone or marker, a
burial flag, and a Presidential Memorial Certificate, at no cost to the family. Some veterans may also be eligible for
Burial Allowances. There are not any benefits available to spouses and dependents buried in a private cemetery.
BENEFITS INFORMATION
Military veterans and their dependants are entitled to a variety of benefits depending on their circumstances.
Contact the Veterans Affairs office to determine what benefits can be claimed and then gather the information
requested.
BEFORE YOU FILE, YOU WILL NEED…
 A copy of the DD214 (Enlisted Record and Report of Separation)
 A copy of marriage certificate
 Copy of the death Certificate
 Paid receipts for funeral and cemetery expenses
 Social Security number for yourself and any dependent children (must provide a birth certificate)
IF YOU OR THE VETERAN WAS PREVIOUSLY MARRIED…
 A certified copy of the divorce decree, or a Death Certificate proving the previous marriage was dissolved by
divorce or death
IF YOU ALREADY HAVE A VA CLAIM NUMBER…
 You must furnish the VA with the claim number assigned to you
Information relating to veterans benefits for any discharged veteran of the U.S. Armed Forces and their dependents
may be obtained from any of the following locations:
CITRUS
2804 W. Marc Knighton Ct.
Suite B140
Lecanto, FL 34461-8334
Phone: 352-527-5915
Fax: 352-527-5916
LAKE
Office: 1300 Duncan Dr. Bldg. B
Mail: PO Box 7800
Tavares, FL 32778-7800
Phone: 352-742-6585
Fax: 352-742-6588
HERNANDO
7479 Forest Oaks Blvd.
Spring Hill, FL 34606
Phone: 352-754-4033
Fax: 352-754-4094
MARION
2528 E. Silver Springs Blvd,
Ocala, FL 34470-7010
Phone: 352-671-8422/23
Fax: 352-671-8424
~6~
SUMTER
8033 E CR 466
Suite B Box 9
The Villages, FL 32162
Phone: (352) 753-2686
Fax: (352) 568-6676
- or 910 N Main Street
Bushnell, FL 33513
Phone: 352-793-0235
Fax: 352-569-6064
VITAL STATISTICS INFORMATION
The Funeral Home prepares the death certificate from the information below. The average time span for
processing the certificate ranges from 3-7 business days. The family will be contacted when the certified copies
are completed and ready to be picked up or mailed to you.
In the State of Florida, the death certificate is issued in two different forms: the long form, which states the
cause of death and the short from, which does not state the cause of death. Counties vary the assessed fee per
certified copy. Average cost is $7 to $15 each. The Funeral Director can provide cost information and will
order them on your behalf. For your convenience, the fees will be added to your Funeral Home bill.
Please use the following information to determine how many of each you will need to order:
o
o
o
o
o
o
o
o
LONG FORM
(with cause of death)
Department of Health
(The Bureau of Vital Statistics)
Life Insurance Policies (1) per Co.
Employee Benefits
Auto Insurance
(Only if car accident caused death)
Social Security Administration
Veterans Administration
o
o
o
o
o
o
o
SHORT FORM
(without cause of death)
Bank Accounts (1) per institution
Stocks, Bonds, Mutual Funds
Title Transfers (ie: Vehicles and Property)
Credit Cards
Internal Revenue Service
Filing Will / Probate Court
Personal Records
*It is recommended that you purchase two extra copies for future use. If you need additional copies later you
may contact the Funeral Home or the Health Department directly.
HEALTH DEPARTMENT
The funeral home is required to file the death certificate at the Health Department within the county of death.
The funeral home can purchase the initial certified certificates. If you need additional copies later you may
contact the funeral home or the Health Department directly. Below is a list of local Health Departments. If you
do not see the county that you require listed, the funeral home will be able to provide you with information
regarding any Florida Health Department or you can visit: http://doh.state.fl.us/chdsitelist.htm
Alachua County Health Department
224 SE 24th Street
Gainesville, Florida 32641
352-334-7900
Orange County Health Department
832 West Central Blvd., Suite 305
Orlando, Florida 32805
407-836-7155
Hernando County Health Department
1570 Flight Path Drive
Brooksville, Florida 34604
352-540-6800
Citrus County Health Department
3700 West Sovereign Path
Lecanto, Florida 34461
352-527-0068
Lake County Health Department
16140 US Hwy 441
Eustis, Florida 32726
352-483-7926
Hillsborough County Health Department
1105 East Kennedy Boulevard
Tampa, Florida 33602
813-307-8000
~7~
Marion County Health
Department
1801 S.E. 32nd Avenue
Ocala, Florida 34478
352-629-0137
Sumter County Health
Department
415 East Noble Avenue
Bushnell, Florida 33513
352-793-6979
VITAL STATISTICS INFORMATION CONTINUED
The Death Certifficate is a leg
gal documen
nt. It is imp
perative tha
at the inform
mation subm
mitted is accu
urate and
everyything is speelled correcttly.
~8~
OBITUARY OPTIONS & COSTS
THE DAILY COMMERCIAL
 Free Death Notice- Lists name, age, date of death, city and funeral home
 Obituary-Regular obituary listing any information the family desires. For example: name, age, date of death, place of
death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
 $10 for a photograph
 The average obit is between $50 and $100 ($47.25 for the first 25 lines then $2 each additional line)
THE DAYTONA NEWS JOURNAL
 Free Death Notice-Lists name, age, date of death, city and funeral home
 Obituary- Regular obituary listing any information the family desires. For example: name, age, date of death, place
of death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
 $60 for a photograph
 The average obit is between $100 and $200
OCALA STAR BANNER
 Free Death Notice- Lists name, age, date of death, city and funeral home
 Obituary-Regular obituary listing any information the family desires. For example: name, age, date of death, place of
death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
 Photograph included in charge
 The average obit is between $150 and $250
THE ORLANDO SENTINEL
 Free Death Notice- Lists name, age, date of death, city and funeral home
 Obituary-Regular obituary listing any information the family desires. For example: name, age, date of death, place of
death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
 $75 for a photograph
 The average obit is between $150 and $250 ($4.95 per line)
THE OUTPOST & EUSTIS NEWS
 Regular obituary at no charge
SUMTER COUNTY TIMES
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Free Death Notice – Lists name, age, city of residence, date of death, name of immediate family, service information
and funeral home
Obituary-Regular obituary listing any information the family desires. For example: name, age, date of death, place of
death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
$10 for a photograph
The newspaper reserves the right to edit the obit
The cost for the obit is $8 per column inch (6 column format)
SUMTER EXPRESS

Regular obituary at no charge
SUMTER SHOPPER

Regular obituary at no charge
THE VILLAGES DAILY SUN
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
Free Obituary- Regular obituary listing any information the family desires. For example: name, age, date of death,
place of death, place of birth, date moved to area, occupation, religion, survivors, funeral home and service times.
Photograph included in charge
The newspaper reserves the right to edit the obit
~9~
OBITUARY & BIOGRAPHY INFORMATION
FULL NAME:
AGE:
CITY OF RESIDENCE:
DATE OF DEATH:
CAUSE OF DEATH:
BIRTHPLACE - CITY/STATE:
YEAR MOVED TO CENTRAL FLORIDA:
MOVED FROM - CITY/STATE:
RELIGIOUS AFFILIATION - CHURCH MEMBERSHIP:
ORGANIZATIONAL AFFILIATIONS:
MILITARY SERVICE - BRANCH & VETERAN OF WAR(S):
OTHER INTERESTING FACTS:
IN LIEU OF FLOWERS:
LIST IMMEDIATE SURVIVORS: Indicate relationship to the deceased and city & state of residence
o
As a courtesy to local families, the Death Notice is printed free of charge in the local papers, per family’s
request. This type of notice consists of name, age, city and funeral home name.
o
There is an assessed fee by the papers for the Funeral Notice, which announces service times and locations.
The family has the option to submit additional information and a photo in this paid notice.
o
The obituary may be posted in out of town publications for a fee assessed by the newspaper.
o
Beyers Funeral Home can place an obituary with a picture on their website at no additional charge, upon
request.
For your convenience, the funeral notice and any out of town obituary fees will be added to your Funeral Home
bill.
~ 10 ~
FUNERAL ESCORTS/LAW ENFORCEMENT
Our Law Enforcement provides our families assistance for the funeral procession to the cemetery, free of charge. If
you feel the service was helpful, and you would like to send them a note of gratitude, below are the names and
addresses of the various Police and Sheriff Departments providing escort service:
Fruitland Park Police Dept.
506 W. Berckman St.
Fruitland Park, FL 32731
Eustis Police Dept.
109 W. Orange Ave.
Tavares, FL 32726
Marion Co. Sheriff’s Dept.
PO Box 1987
Ocala, FL 34478
Lake Co. Sheriff’s Dept.
315 W. main St.
Tavares, FL 32778
Leesburg Police Dept.
115 E. Magnolia St.
Leesburg, FL 34748
Tavares Police Dept.
201 E. Main St.
Tavares, FL 32778
Mount Dora Police Dept.
1300 N. Donnelly St.
Mt. Dora, FL 32757
Sumter Co. Sheriff’s Dept.
PO Box 188
Bushnell, FL 33513
Umatilla Police Dept.
PO Box 42
Umatilla, FL 32784
Lady Lake Police Dept.
409 Fennell Blvd.
Lady Lake, FL 32159
SOCIAL SECURITY BENEFITS AND INFORMATION
HOW TO APPLY FOR BENEFITS:
You can apply for benefits by telephone or by visiting any Social Security office. You may need some of the
documents listed below; but don’t delay with the application process if you do not have all of the information. If you
do not have a document that you need, Social Security can help you get it.
INFORMATION NEEDED:







Your Social Security number and the deceased worker’s Social Security number
A death certificate (the funeral director provides a statement that can be used as well)
Proof of the deceased worker’s earnings for last year (W-2 forms or self-employment tax return)
Your birth certificate
A marriage certificate, if you are applying for benefits as: widow/widower, divorced wife/husband
 A divorce decree, if you are applying for benefits as a divorced wife/husband
Children’s birth certificates and Social Security numbers, if applying for children’s benefits
Your checking/savings account information (if you would like direct deposit of the benefits)
*You will need to submit original documents or certified copies by the issuing office
*You can mail or bring the documents to the office. Social Security will make photocopies and return the documents.
SUPPLEMENTAL SECURITY INCOME (SSI):
If you are 65 or older, disabled, or blind, ask the Social Security representative about Supplemental Security Income
(SSI) funds for people with limited income and resources. If you receive SSI, you may also qualify for Medicaid, food
stamps, and other social services.
FOR MORE INFORMATION:
For more information, write or visit any Social Security Office, or phone the toll-free number: 1-800-772-1213 or
locally: 352-787-2624. You can speak to a representative weekdays 7am to 7pm.
A REMINDER:
If the deceased was receiving Social Security benefits, any checks which arrive after death will need to be returned to
the Social Security office. If the funds are directly deposited into a bank account, the bank will need to be notified of
the death as well.
~ 11 ~
PROCEDURES REQUIRED PRIOR TO CREMATION
A Funeral Director must meet with the next of kin and secure statistical documentation that will appear on the
death certificate. Once that is done the document will be hand delivered (unless out of County) to the Doctor’s
office at the earliest time available. While we are open for business seven days a week, the Doctor’s office may
be closed on weekends and/or holidays. The Doctor’s office will contact the Funeral Home as soon as he/she is
able to fill out the cause of death and sign the document. We will then pick up the certificate at our soonest
availability, upon receiving the phone call.
The document is then faxed to the Medical Examiner’s office for a state required cremation approval. The
process may take several hours up to several days. The Medical Examiner’s office has complete and total
control on how fast the process will take. If the Medical Examiner’s office should require a review of the
deceased’s medical records, it will, and often does, delay receiving the Cremation Approval required by the
Funeral Home and the state.
The Funeral Home requires the next of kin(s) to sign an authorization for cremation – allowing the Funeral
Home to legally proceed with the process. Signature by a spouse, or if there is no spouse, ALL CHILDREN
MUST sign the AUTHORIZATION, or if there are no children, Parent(s), or Brother(s) and Sister(s), or
Grandchildren – in this order.
The Funeral Home can accept a letter by a child/sibling if the whereabouts of any other child/sibling is not
known. The person signing will be fully responsible for the child/sibling and state that they know of no such
reason why this person would object to the cremation.
In the event that the qualifying next of kin are not present, our forms can be faxed/emailed to the authorizing
party where these signatures can be secured along with a required notary signature and stamp to be affixed.
The document may be faxed back to the Funeral Home. The original signed, notarized paperwork must be
mailed back to the Funeral Home as soon as possible.
IN SUMMARY, THE FOLLOWING MUST OCCUR:
1.
2.
3.
Obtain a completed and signed original of the death certificate
Obtain Cremation Authorization from the Medical Examiner’s office
Obtain the required authorization from the closest next of kin(s)
Once these requirements are in place we will then schedule, (in order of receiving completed documentation),
the cremation to take place in our crematory located at our Leesburg facility. There is a high probability that
other cremations will already be in the schedule ahead of your loved one.
Realize the cremation process from time of death, until we have the Cremated Remains available for
disposition may be seven days or more, or in as little as 60 hours (2 ½ days) from the time of death.
Under no circumstances may the cremation take place earlier than 48 hours, as mandated by state law. We
strive to procure all documentation in the most expedient manner, but please be aware of the limitations and
requirements we are under.
Do not agree to or initiate a time for service if you have expectations of having the urn present for the services,
such as a Graveside service. Some religions will require the Cremated Remains for the Funeral Service (i.e.
Roman Catholic), while others have no such requirements (most Protestant religions). Our Funeral Directors
will assist you in setting a time of service.
~ 12 ~
AFTER DEATH FOLLOW-UP CHECKLIST
____ 1. Send acknowledgement card for flowers, memorial donations, food and spiritual remembrances
____ 2. Transfer of Real Estate Properties:
a. Apply for Widowed Person’s Exemption
b. Apply for Homestead and Disability Exemption
____ 3. Notify insurance companies and file claims:
a. Life, Homeowners, Auto Insurance
b. Medical, Health, Disability, Travel and Accident
c. Retirement Benefits and Annuities
____ 4. Apply for appropriate benefits:
a. Social Security Survivors Benefits for spouse/dependents
b. Veteran’s Burial and Survivor’s Benefits
c. Pension Benefits
d. Workmen’s Compensation Benefits
e. Civil Service/Railroad Retirement
____ 5. Income Tax:
a. Notify Account/Tax Consultant or Attorney
____ 6. Stocks/Securities:
a. Change ownership of joint or solely owned stocks
b. IRA or Retirement accounts
c. Transfer Bonds, Mutual or other Funds
____ 7. Bank Requirements:
a. Change all jointly held accounts
b. Cancel direct deposit benefit payments
c. Re-establish Safe Deposit Box
d. Re-establish all outstanding mortgages, personal notes, etc.
e. Apply for credit life insurance on loans, mortgages, etc.
f. Certificates or Deposit, IRS
____ 8. Notify Department of Motor Vehicles:
a. Transfer titles of all registered vehicles, mobile homes, boats, motor homes, motorcycles, etc.
registered in deceased name.
____ 9. Notify Credit Card Account Companies:
a. Apply for credit life insurance
____ 10. Notify Attorney:
a. If a Will must be probated
b. If your Will needs to be revised
c. About a Living Will or Trust
____ 11. Cancel Deceased’s voter registration and driver’s license
____ 12. Please have a Financial Professional assist me with this
____ 13. Establish Pre-Arranged Funeral
~ 13 ~
WAYS TO PERSONALIZE THE SERVICE
The Funeral Director and staff will assist you in making this final tribute as personal and meaningful as you
desire.
o
CLOTHING - Select their favorite clothing.
o
PICTURES - Magnetic picture boards and easels are available for you to display photos, slide shows can
be created and displayed, as well as video tributes. For details and options available, consult your
Funeral Director.
o
FLOWERS - Select flowers they especially liked. You may order the flowers directly from your florist or
if you prefer, we can order the flowers and place the cost on the Funeral Home bill.
o
IN LIEU OF FLOWERS - You may specify in the paid funeral notice and at the service that in lieu of
flowers you request donations be made to your favorite charity, memorial fund or scholarship fund.
o
MUSIC – Songs that you would like to hear can be played on our sound system.
REMINDER CHECKLIST
Please bring the following with you to the arrangement interview that you will have with the Funeral Director:
o
VITAL STATISTIC INFORMATION
o
OBITUARY INFORMATION
o
CLOTHING (including undergarments, glasses and jewelry)
o
PHOTOS (for memory board, if using, for obituaries, or for visual assistance if needed)
o
DD 214 (Military Discharge Papers)
o
INSURANCE POLICIES
o
CLERGY NAME AND PHONE NUMBER
o
COPIES OF PRE-NEED CONTRACTS
~ 14 ~
OUR PAYMENT POLICY
Beyers Funeral Home and Crematory has established a uniform payment policy to serve all families fairly and
to prevent misunderstandings. This payment policy enables us to contain our costs to all the families that we
serve.
Our policy requires that arrangement for payment must be made during the arrangement conference with
payment due before services are rendered.
THE FOLLOWING ARE ACCEPTABLE PAYMENT OPTIONS:
1) Cash
2) Checks, which are subject to electronic verification
3) VISA, MasterCard, or Discover
4) Assignable insurance, for the face value of the policy only, once the assignability and beneficiary have been
verified by the insurance company. Policies under two years old are generally contestable and may not be
acceptable. When acceptable insurance has been assigned, a monthly statement will be sent to the purchaser
until payment is received from the insurance company. When payment is received, a statement will be sent
showing the amount, date, and paid in full or new balance due.
We do not accept future payment from “Estate Funds”
DISCLAIMER OF WARRANTIES
Beyers Funeral Home makes no representations or warranties regarding caskets, outer burial containers, urns,
or other funeral goods sold by the Funeral Home. The only warranties, expressed or implied, granted in
connection with goods sold with this funeral service are the express written warranties, if any, extended by the
manufacturers thereof. No other warranties of merchandise fitness for a particular purpose are extended by
the Funeral Home.
Thank you for your confidence in selecting our firm to assist you with the
memorialization of your loved one.
~ 15 ~
R
ECORD OF
PERSONAL AFFAIRS
ATTORNEY
Name___________________________________
Address _________________________________
Phone __________________________________
ACCOUNTANT
Name___________________________________
Address _________________________________
Phone __________________________________
EXECUTOR
Name___________________________________
Address _________________________________
Phone __________________________________
STOCKBROKER
Name___________________________________
Address _________________________________
Phone __________________________________
Stock Certificates are Located __________________
BANK ACCOUNTS — SAVINGS — CHECKING
Bank Name ________________________________
Address _________________________________
Account Type _____________________________
Account Number ___________________________
Bank Name ________________________________
Address _________________________________
Account Type _____________________________
Account Number ___________________________
Bank Name ________________________________
Address _________________________________
Account Type _____________________________
Account Number ___________________________
Bank Name ________________________________
Address _________________________________
Account Type _____________________________
Account Number ___________________________
ADDITIONAL INFO/CONTACTS
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
ADDITIONAL INFO/CONTACTS
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
401K/IRA AND RETIREMENT PLAN BENEFITS
 Name of Company___________________________
Account Number ___________________________
Contact Information _________________________
AUTOMOBILE REGISTRATIONS
Located _________________________________
Name of Company___________________________
Account Number ___________________________
Contact Information _________________________
REAL ESTATE BROKER
Name___________________________________
Address _________________________________
Phone __________________________________
PROPERTY OWNED
Location_________________________________
Deed ______ Mortgage Company _______________
Location_________________________________
Deed ______ Mortgage Company
WILL
Original is Located _________________________
Copy is Located ____________________________
Date of Will Preparation ______________________
Attorney Who Prepared ______________________
Executor of Will ___________________________
Witnesses to Will __________________________
LIVING WILL
Yes ______ No ______
Location of Living Will _________________________
THERE IS NO WILL AND SUGGEST THE FOLLOWING BE
ADMINISTRATOR OF ESTATE
Name___________________________________
Address _________________________________
Phone __________________________________
SAFE DEPOSIT BOX
Name of Bank _____________________________
Address _________________________________
Phone __________________________________
In Whose Name? ___________________________
Key is Located? ____________________________
MARRIAGE CERTIFICATE
Location_________________________________
INCOME TAX RETURN
Location ________________________________
ADDITIONAL INFO/CONTACTS
_________________________________________
BIRTH CERTIFICATE
Location_________________________________
F
UNERAL
ARRANGEMENTS
FUNERAL HOME TO BE CONTACTED
Funeral Home Name ________________________
Address _________________________________
Phone __________________________________
Pre-arranged Funeral Made ___________________
Pre-arrangement Contact _____________________
Located _________________________________
CEMETERY INFORMATION
Name of Cemetery Desired ____________________
Address _________________________________
Phone __________________________________
Plot in Whose Name ________________________
Plot Number ______________________________
Section _________________________________
Block ___________________________________
Location of Deed ___________________________
CREMATION
Disposition of Ashes ________________________
_______________________________________
FUNERAL SERVICE TO BE HELD
Church _________________________________
Funeral Home ____________________________
Other __________________________________
B
CLERGY OR LAYPERSON
Name __________________________________
Address _________________________________
Phone __________________________________
Music __________________________________
_______________________________________
_______________________________________
Scripture/Reading Selections __________________
_______________________________________
_______________________________________
Clothing _________________________________
_______________________________________
Visitation—Calling Hours _____________________
_______________________________________
Pallbearers _______________________________
_______________________________________
_______________________________________
_______________________________________
Flowers Yes ______ No ______
Memorial Donations
Yes ______ No ______
Name of Charity ___________________________
_______________________________________
Lodge or Military Service—Contact: ______________
_______________________________________
Other Personal Requests—Contacts: ______________
_________________________________________
_________________________________________
IOGRAPHICAL INFORMATION
EDUCATION
High School Attended _______________________
Dates ____________ Graduated (Date) __________
College Attended __________________________
Dates ____________ Graduated (Date) __________
Degree __________________________________
College Attended __________________________
Dates ____________ Graduated (Date) __________
Degree __________________________________
CHURCH MEMBERSHIP OR AFFILIATION
_________________________________________
_________________________________________
EMPLOYMENT
Place of Employment ________________________
Position Held _____________________________
Dates ___________________________________
Place of Employment ________________________
Position Held _____________________________
Dates ___________________________________
Place of Employment ________________________
Position Held _____________________________
Dates ___________________________________
Place of Employment ________________________
Position Held _____________________________
Dates ___________________________________
ORGANIZATIONS
Fraternal, Service, Social and Union membership _____
_______________________________________
_______________________________________
_______________________________________
Location of Fraternal or Other Organizational Jewelry
_______________________________________
Political Positions Held ______________________
_______________________________________
Other Boards Served On ______________________
_______________________________________
Special Recognitions (ie athletic, religious, scientific, etc)
_______________________________________
_______________________________________
VETERAN’S SERVICE
Full Name of Veteran ________________________
Pension or VA Claim No. _____________________
Service Serial Number _______________________
Date Entered Service ________________________
Branch of Service __________________________
Grade or Rank ____________________________
Co.—Reg.—Div. ____________________________
Name of War or Conflict ______________________
Date & Place of Discharge ____________________
Decorations ______________________________
Medal of Honor Recipient ___Yes ___ No
Flag Request ___ Draped on Casket ___ Not Draped
Additional Military Info ______________________