Memorial Planner and Information

for

[Declarant]

This document is intended to help my family and friends during any last illness and at the time of my passing. It is divided into three areas: 1. Information for my last illness, 2. Estate planning, and 3. Memorial preferences.

I understand that you are not legally obligated to comply with my desires concerning services and the like. However, I would like for you to you comply with these wishes, so long as doing so does not create an undue burden or financial hardship.

Any estate planning documents (such as wills and trusts) or advance health care directives (such as a living will or health care power of attorney) mentioned herein are important legal instruments. Nothing in this document amends or changes the terms of those legal instruments. My failure to mention all of those documents or to identify any of them properly should not be construed as expressing my intent to amend or revoke any instrument.

Information for my last illness

1. Advance Care Documents:

I have signed the following instruments concerning my treatment during any final illness or if I am unable to communicate my own health care preferences: [Advance Care Documents]

2. Organ Donation:

I have signed the following document(s) concerning donation of my organs: [Organ Donation Statement].

Memorial Preferences

1. Notification:

Please notify [People to Notify] at the time of my death.

2. Funeral Home/Director:

Arrangements [Have or Have Not] been made in advance for funeral services. Please contact [Funeral Director] to complete my final arrangements.

3. Post-mortem Examination:

If it is elective, I prefer that there [Be or Not Be] an autopsy performed on my body.

4. Treatment of Body:

[Treatment Options]

5. Disposition of Remains:

I prefer that my remains be handled as follows: [Disposition Directions]

6. Services:

Following are my wishes concerning holding various kinds of services:

a. Funeral - [Funeral Preferences]

b. Memorial Service - [Memorial Preferences]

c. Wake - [Wake Preferences]

d. Visitation: [Visitation Preferences]

7. Flowers, Memorial Funds, Donations:

[Flowers/Contributions Preferences]

8. Pallbearers:

Please ask the following people to serve as my pallbearers: [Pallbearers]

If any of the persons named are unable to serve for any reason, I would like you to ask the following persons to serve as alternate pallbearers, in this order: [Alternate Pallbearers]

My Estate Planning Information

1. Estate planning documents:

I have signed [Document Name(s)] regarding the disposition of the assets of my estate and related matters. These estate planning documents are located [Document Location(s)].

2. Life Insurance.

Following are my life insurance policies: [Life Insurance Policies]

3. Safe deposit box:

I [Do or Do Not] have a safety deposit box. The safety deposit box is at [Bank Name]. My key is stored [Key Location].

In the event that there is more than one statement about any of these matters, the one with the latest date is the final expression of my preferences and supersedes any statement with an earlier date.

Name:______________________________ Dated: _______________________

[Declarant]

[Declarant's Address]