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The Estate Planning Guide


“Show me the manner in which a nation cares for its dead and I will measure with mathematical exactness the tender mercies of its people, their respect for the laws of the land and their loyalty to high ideals.” — SIR WILLIAM GLADSTONE

1


The Problem If there had been a death in your family yesterday, what would you be doing today? Where would you turn? Loans? Friends? Savings? Government Assistance? Insurance is dollars only. It does not guarantee the funeral or cemetery prices against inflation. It cannot make important emotional decisions for you. It is not guaranteed to be available after a serious illness or accident.


The Solution • Simple actions today to avoid heartache tomorrow. • Important documents and papers organized. • Cemetery and Memorialization Plans completed. • Funeral and/or Cremation Plans completed.


Three important facts to remember...


FACT 1 67% of all final arrangements are made by widows and children.


FACT 2 Since 1933, the cost of dying has increased 25% faster than the cost of living.


FACT 3 Currently, funeral, cremation and cemetery costs nearly double every ten years. (Review Cypress Lawn Historical Records)


Advantages of Pre-planning

• Assures Planning Together • Offers Choice Location Now • Protects Family • Conserves Insurance • Secures Savings • Halts Inflation • Provides Peace of Mind • Saves Time • Avoids Forced Decisions Later • Gives Mental Satisfaction • Removes Doubt • Guarantees Endowment Care


To Our Loved Ones It is our wish that you be spared from anxiety, expense and inconvenience at the time of our death. In this Estate Planning Guide, you will find information which we have recorded, and planning which represents arrangements made in advance. We hope in this way to relieve our family in the time of need. If you will give these to our funeral director, everything will be conducted in accordance with our wishes. In this guide we have recorded certain vital statistics that will be needed, as well as other information you will need. We sincerely hope you will find these arrangements satisfactory and that they will help you retain a warm memory of the wonderful years we have spent together. God bless all of you.

Signed ___________________________ Signed ___________________________ Date: ____________________________

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About Your Confidential

Estate Planning Guide

One of the most difficult burdens that survivors face after the loss of a loved one is gathering and organizing the deceased’s personal and financial records. This Estate Planning Guide deals thoughtfully with the one true inevitability of life, and has been designed to provide you a place to record virtually all of the vital personal and financial data that will one day be needed.

CONTENTS Letter to Our Loved Ones ....................................... 2 About Your Estate Planning Guide ........................ 3 Wills and Important Documents ........................... 4 Insurance Policies and Bank Accounts ................... 5 Husband’s Personal Statistics and History ............. 6 Wife’s Personal Statistics and History .................... 7 Veteran’s Information and Benefits ...................... 8 Social Security Information and Benefits .............. 9 Family Financial Status .................................. 10,11 Relatives, Friends and Advisors ...................... 12,13 Memorial Instructions – Husband ....................... 14 Memorial Instructions – Wife .............................. 15 Living Will Information and Declaration .........16-21 Checklist of Things to Do ...................................... 22

This Estate Planning Guide is as useful as you make it. A place for the needed information has been set forth in a concise and practical manner, but it needs you to complete it. By keeping this Guide up to date, you will provide an important, ready reference for your family members at a most difficult time. By taking the time to fill out these pages, you will gain the peace of mind in knowing that your loved ones will be guided by your wishes. Many of their questions will have already been answered because of your thoughtfulness. We suggest that, once you complete this Estate Planning Guide, you keep it in a secure but accessible place, for the use of those who will need it.

3


Wills, Living Trusts and Important Documents Everyone should be safeguarded by a properly drawn and executed Will. Without a Will, state laws and the courts will decide how your assets and even the future of your minor children are to be treated. The absence of a Will deprives you from making the decisions about how YOU want these important issues resolved.

Upon death, your Will must be probated in court. The court must approve the executor, and an estate inventory must be prepared and filed. Taxes and debts must be recognized. Often, the services of an attorney and or accountant must be utilized. Since much difficulty and hardship can be encountered at the time of death, delays and expenses can be more severe without competent, professional assistance. Homemade or “do-it-yourself�

The preparation of a Will is not a one-time event. A Will should be reviewed every few years in the context of changing family status, obligations, tax laws ad wishes that you may have.

Wills often do not stand up in court. It is thus recommended that you seek reliable, professional assistance in the preparation of your Will, that you update it regularly as circumstances dictate, and that you consider carefully your selection of the executor for your estate. These issues are of vital importance for the protection of your estate and, most importantly, for the protection of those left behind.

Husband

Wife

Date of Will or Trust: __________________

Date of Will or Trust: ___________________

Location of Will or Trust: _______________

Location of Will or Trust: ________________

____________________________________

_____________________________________

Important Papers Locator S Safe Deposit Box

H Home

O Office

L Lawyer

E (Specify Elsewhere)

Insurance Policies

Bank Books

Birth and Marriage Certificates

Promissory Notes

Tax Returns

Stocks and Bonds

Diplomas

Certificate of Ownership

(Cemetery/Mausoleum

Property)

Military Papers Notes and Obligations Social Security Cards Bills of Sale, Titles Deed to Home Funeral Plan (Insurance/Trust)

4


Insurance Policies _____________________________________________________________________________________________________________________________ NAME OF INSURED BENEFICIARY _____________________________________________________________________________________________________________________________ INSURANCE COMPANY POLICY # AMOUNT OF BENEFIT _____________________________________________________________________________________________________________________________ NAME OF INSURED BENEFICIARY _____________________________________________________________________________________________________________________________ INSURANCE COMPANY POLICY # AMOUNT OF BENEFIT _____________________________________________________________________________________________________________________________ NAME OF INSURED BENEFICIARY _____________________________________________________________________________________________________________________________ INSURANCE COMPANY POLICY # AMOUNT OF BENEFIT _____________________________________________________________________________________________________________________________ NAME OF INSURED BENEFICIARY _____________________________________________________________________________________________________________________________ INSURANCE COMPANY POLICY # AMOUNT OF BENEFIT _____________________________________________________________________________________________________________________________ NAME OF INSURED BENEFICIARY _____________________________________________________________________________________________________________________________ INSURANCE COMPANY POLICY # AMOUNT OF BENEFIT

Bank Accounts _____________________________________________________________________________________________________________________________ NAME ON ACCOUNT ACCOUNT # TYPE OF ACCOUNT _____________________________________________________________________________________________________________________________ BRANCH NAME AND ADDRESS _____________________________________________________________________________________________________________________________ NAME ON ACCOUNT ACCOUNT # TYPE OF ACCOUNT _____________________________________________________________________________________________________________________________ BRANCH NAME AND ADDRESS _____________________________________________________________________________________________________________________________ NAME ON ACCOUNT ACCOUNT # TYPE OF ACCOUNT _____________________________________________________________________________________________________________________________ BRANCH NAME AND ADDRESS _____________________________________________________________________________________________________________________________ NAME ON ACCOUNT ACCOUNT # TYPE OF ACCOUNT _____________________________________________________________________________________________________________________________ BRANCH NAME AND ADDRESS

Safety Deposit Box Located At: ____________________________________________________ ______________________________________ Location of Key(s): _______________________

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Husband’s Personal Statistics and History Full Name: _______________________________________________________________________ Residence Address: ________________________________________________________________ Birthplace: ________________________________________ Birth Date: ____________________ Social Security Number: _____________________ Spouse Maiden Name: ____________________ Marital Status: _____________________________________

Name of Spouse: ______________________

Marriage: _______________________________________________________________________________ Name and Birthplace of Father: ______________________________________________________________ Name and Birthplace of Mother: _____________________________________________________________ Professional Statistics: _____________________________________________________________________ Company

Job Title

From

To

Professional Achievements: _________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Schools Attended _________________________________________________________________________ From

To

Degree

_________________________________________________________________________ From

To

Degree

Civic or Public Offices Held: _________________________________________________________________ Office Held

From

To

_______________________________________________________________________________________ Office Held

From

To

Organization Affiliations: ___________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Veteran: ________________________________________________________________________________ Name of War or Dates Served: ______________________________________________________________ Organization: ______________________________________________ Rank: ________________________ Enlisted at: ______________________________________________________________________________ Location of Discharge Certificate: ____________________________________________________________ Citations, Recognitions or Awards: ___________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 6


Wife’s Personal Statistics and History Full Name: _______________________________________________________________________ Residence Address: ________________________________________________________________ Birthplace: ________________________________________ Birth Date: ____________________ Social Security Number: _____________________________________________________________ Marital Status: _____________________________________

Name of Spouse: ______________________

Marriage: _______________________________________________________________________________ Name and Birthplace of Father: ______________________________________________________________ Name and Birthplace of Mother: _____________________________________________________________ Professional Statistics: _____________________________________________________________________ Company

Job Title

From

To

Professional Achievements: _________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Schools Attended _________________________________________________________________________ From

To

Degree

_________________________________________________________________________ From

To

Degree

Civic or Public Offices Held: _________________________________________________________________ Office Held

From

To

_______________________________________________________________________________________ Office Held

From

To

Organization Affiliations: ___________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Veteran: ________________________________________________________________________________ Name of War or Dates Served: ______________________________________________________________ Organization: ______________________________________________ Rank: ________________________ Enlisted at: ______________________________________________________________________________ Location of Discharge Certificate: ____________________________________________________________ Citations, Recognitions or Awards: ___________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

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Veteran’s Information and Benefits

As an honorably discharged veteran, you or your family may be entitled to a number of benefits, ranging from educational and medical benefits for you to various forms of death benefits for your survivors. Also please be aware that veteran’s benefits must be applied for: they are not paid automatically. There is a time limit to your claiming benefits or they will be lost. When filing a claim for veterans benefits most or all of the following documents will be needed:     

Veteran’s death certificate Veteran’s discharge papers Copy of veteran’s marriage certificate Birth certificates of veteran’s minor children Receipt of itemized funeral bill for veteran

Information and applications are also available online at the webpage of the US Department of Veterans Affairs at www.VA.gov Types of benefits available and criteria for qualification change from time to time, so it is important to obtain pertinent, up-to-date information. You can contact your local or regional office of the US Department of Veterans Affairs for current information on benefits and claims procedures, or call the Department of Veterans Affairs at: 202-273-5400

or write: Department of Veterans Affairs 810 Vermont Avenue, N.W. Washington, DC 20420

or e-mail: http://www.VA.gov

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Social Security Information and Benefits Social security benefits can play a vital role in planning your family's future. Most of us are entitled to some type of benefit, but the nature of the benefit(s) and the qualifications thereof are subject to change. Thus, it is important to obtain timely information every few years on what benefits may be due. It is also important to remember Social Security benefits must be applied for: they are not paid automatically. Also, benefits must be applied for within a specific time frame. To facilitate the filing of a claim for your Social Security benefits, you will need most or all of the following documents:        

Death certificate Birth certificate of Deceased Social Security Card of Deceased Marriage certificate (copy) Birth Certificate of Applicant Birth Certificate of Minor Children Disability Proof for Children over 18 Receipted Funeral Bill

In addition to various retirement and support payment that you may be eligible for while alive, there are certain lump sum available benefits for which your spouse may qualify. Also the widow/widower, dependent children or dependent parents may be eligible to receive benefits. You can contact your local Social Security Office for current information on benefits and claims procedures, or call the national toll-free number at 1-800-772-1213, or online at: http://ssa-custhelp.ssa.gov/

You may also write to your local office, or to the national social security office at: Social Security Administration Office of Public Inquiries Windsor Park Building 6401 Security Blvd. Baltimore, MD 21235 This site offers language assistance including Arabic, Spanish and Asian dialects. To find out the current status of your Social Security account, fill out and return the enclosed Request for Social Security Statement.

Information and applications are also available online at the webpage of the US Social Security Administration at http://www.SSA.gov

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Family Financial Status ASSETS

Date

Cash on hand and in banks

Date

Date

$

$

$

TOTAL ASSETS $

$

$

U.S. Government and Marketable Securities (see schedule A) Non-Marketable Securities (see schedule B) Account and Notes Receivable (see schedule C) Real Estate (see schedule D) Cash Value - Life Insurance (see page 3) Automobiles and Personal Property Other Assets - Itemize

LIABILITIES

Date

Notes Payable to banks – secured (see schedule E)

Date

Date

$

$

$

TOTAL LIABILITIES $

$

$

Notes Payable to banks - unsecured (see schedule E) Notes Payable to others (see schedule E) Account and Bills due (see schedule E) Unpaid taxes and interest Real Estate Mortgages (see schedule D) Other debts - itemize

10


Family Financial Status Schedule A -- U.S. Government and Marketable Securities Number of Shares

Description

In Name Of

Cost

Market Value

Cost

Market Value

Schedule B – Unlisted Securities and Other Assets Number of Shares

Description

In Name Of

Schedule C -- Accounts and Notes Receivable Due From

Address

Amount

Schedule D -- Real Estate Owned Address and Type Of Property

Title in Name Of

Date Acquired

Cost

Market Value

Mortgage Maturity

Mortgage Amount

Schedule E -- Notes Payable and Other Debts Payable To

Terms

11

Maturity Date

Net Amount of Loan

Total Amount of Loan


Children and Other Relatives Children to be Contacted Name Address and Telephone Email __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Husband’s Relatives to be Contacted Name Relationship Address and Telephone Email __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Wife’s Relatives to be Contacted Name Relationship Address and Telephone Email __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

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Friends, Advisor & Estate Planners Close Friends to be Notified Name

Relationship

Address and Telephone

Email

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Advisors & Estate Planners to be Notified Name

Relationship

Address and Telephone

Email

__________________ Doctor

___________________________________________________________

__________________ Doctor

___________________________________________________________

__________________ Lawyer

___________________________________________________________

__________________ Lawyer

___________________________________________________________

__________________ Clergy

___________________________________________________________

__________________ Accountant

___________________________________________________________

__________________ Memorial Counselor _______________________________________________________ __________________ Funeral Director __________________________________________________________ __________________ Executor/DPOA ___________________________________________________________

13


Memorial Instructions – Husband __________________________________________________________________________________________ Place of Service Memorial Chapel __________________________________________________________________________________________ Church Denomination Name of Church City State Please Contact:

Minister

Priest

Rabbi

Other _________________________

__________________________________________________________________________________________ Name Address City State Phone Participating Organization (military or fraternal): __________________________________________________ Type of Service:

Open

Closed

Casket: ____________________________________________________________________________________ Metal/Wood/Fiberglass

Color (ext) Color and Material (int)

Flag (yes or no): _____________________________________________________________________________ Fold, Place at head of casket to drape casket

Flowers: ___________________________________________________________________________________

Music

Clothing

Organist: Yes No From Current Wardrobe New Other Selections: ______________________ Jewelry: __________________________________________________ _______________________________ Stays on Soloist:

Yes

No

Return to: ____________________________________

Wedding Ring: _____________________________________________

Selections: ______________________ Stays on

Return to: ____________________________________

_______________________________ Favorite Passage from Bible or Other Literature: __________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Cemetery Decisions Location of Ownership Certificate (Deed for Cemetery Property: _____________________________________ __________________________________________________________________________________________ Name of Cemetery Address City State Zip Type of Property: Mausoleum Lawn Crypt Ground Space Cremation Memorialization Memorial:

Bronze

Granite

Cremation Society

Other _____________________________________________

Inscription: _____________________________________________________ Emblem: ___________________ Special Instructions: _________________________________________________________________________ __________________________________________________________________________________________ Signature: ____________________________________________________ Date: ________________________

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Memorial Instructions – Wife __________________________________________________________________________________________ Place of Service Memorial Chapel __________________________________________________________________________________________ Church Denomination Name of Church City State Please Contact:

Minister

Priest

Rabbi

Other _________________________

__________________________________________________________________________________________ Name Address City State Phone Participating Organization (military or fraternal): __________________________________________________ Type of Service:

Open

Closed

Casket: ____________________________________________________________________________________ Metal/Wood/Fiberglass

Color (ext) Color and Material (int)

Flag (yes or no): _____________________________________________________________________________ Fold, Place at head of casket to drape casket

Flowers: ___________________________________________________________________________________

Music

Clothing

Organist: Yes No From Current Wardrobe New Other Selections: ______________________ Jewelry: __________________________________________________ _______________________________ Stays on Soloist:

Yes

No

Return to: ____________________________________

Wedding Ring: _____________________________________________

Selections: ______________________ Stays on

Return to: ____________________________________

_______________________________ Favorite Passage from Bible or Other Literature: __________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Cemetery Decisions Location of Ownership Certificate (Deed for Cemetery Property: _____________________________________ __________________________________________________________________________________________ Name of Cemetery Address City State Zip Type of Property: Mausoleum Lawn Crypt Ground Space Cremation Memorialization Memorial:

Bronze

Granite

Cremation Society

Other _____________________________________________

Inscription: _____________________________________________________ Emblem: ___________________ Special Instructions: _________________________________________________________________________ __________________________________________________________________________________________ Signature: ____________________________________________________ Date: ________________________

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The Living Will/Advance Directive Today more than ever, issues concerning “death with dignity” or “the right to die” have received increased attention. As advances in medical and scientific techniques to find new ways to maintain bodily functions, keeping the human machine alive, more people have become concerned with “quality of life” issues, in contrast to simple continued existence.

personal and very important to consider. We recommend that you and your family discuss these issues to avoid the uncertainty that could arise at the difficult time of the serious, prolonged illness.

On June 25, 1990,the Supreme Court ruled in the Nancy Cruzan case that Americans do have a constitutional “right to die,” and indicated that a Living Will (Advance Directive) or Durable Power of Attorney (DPOA) may be the best way to protect that right.

On the next page is a Living Will in general language drafted by the State of California Attorney General. As with all of your important decisions, we encourage you to consult with an attorney.

Today, most states have Living Will statutes, specifying documents which anyone can copy and sign according to state law.

You may obtain additional information in regards to your state or about this issue by writing to Choice In Dying at 200 Varick St. NY NY 10014, or call 1-800989-WILL.

Issues concerning the use of “heroic measures” to sustain life, and quality of life issues, are very

CALIFORNIA ADVANCE HEALTH CARE DIRECTIVE PART 1: POWER OF ATTORNEY FOR HEALTH CARE (1) DESIGNATION OF AGENT: I designate the following individual as my agent to make health care decisions for me: (Name of individual you choose as agent)

(street address)

(city) (home phone)

(state)

(zip code)

(work phone)

OPTIONAL: If I revoke my agent’s authority or if my agent is not willing, able, or reasonably available to make a health-care decision for me, I designate as my first alternate agent: (Name of individual you choose as first alternate agent)

(address) (city) (home phone)

(state) (work phone)

16

(zip code)


OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent: (Name of individual you choose as second alternate agent)

(address)

(city)

(home phone)

(state)

(zip code)

(work phone)

(2) AGENT’S AUTHORITY: My agent is authorized to make all health care decisions for me, including decisions to provide, withhold, or withdraw artificial nutrition and hydration, and all other forms of health care to keep me alive, except as I state here:

(Add additional sheets if needed.) (3) WHEN AGENT’S AUTHORITY BECOMES EFFECTIVE: My agent’s authority becomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box. If I mark this box [ ], my agent’s authority to make health care decisions for me takes effect immediately. (4) AGENT’S OBLIGATION: My agent shall make health care decisions for me in accordance with this power of attorney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent. (5) AGENT’S POSTDEATH AUTHORITY: My agent is authorized to make anatomical gifts, authorize an autopsy, and direct disposition of my remains, except as I state here or in Part 3 of this form:

(6) NOMINATION OF CONSERVATOR: If a conservator of my person needs to be appointed for me by a court, I nominate the agent designated in this form. If that agent is not willing, able, or reasonably available to act as conservator, I nominate the alternate agents whom I have named, in the order designated.

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PART 2: INSTRUCTIONS FOR HEALTH CARE If you fill out this part of the form, you may strike any wording you do not want.

(7) END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (Initial only one box) [ _____ ] (a) Choice NOT To Prolong Life I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits, OR [ _____ ] (b) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards. (8) RELIEF FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort should be provided at all times even if it hastens my death:

(9) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that:

(Add additional sheets if needed.)

PART 3: DONATION OF ORGANS AT DEATH (OPTIONAL) (10) Upon my death: (mark applicable box) (a) I give any needed organs, tissues, or parts, OR (b) I give the following organs, tissues, or parts only (c) My gift is for the following purposes: (Strike any of the following you do not want) (1) Transplant (2) Therapy (3) Research (4) Education

18


PART 4: PRIMARY PHYSICIAN (OPTIONAL) (11) I designate the following physician as my primary physician: (name of physician)

(address)

(city)

(phone)

(state)

(zip code)

(other phone)

OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician: (name of physician)

(address)

(city)

(phone)

(state)

(zip code)

(other phone)

(12) EFFECT OF COPY: A copy of this form has the same effect as the original. (13) SIGNATURE: Sign and date the form here: _________________________________________________________________ _______________________ (sign your name) (date)

_________________________________________________________________ (print your name)

(address)

(city)

(state)

(zip code)

(14) WITNESSES: This advance health care directive will not be valid for making health care decisions unless it is either: (1) signed by two (2) qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature; or (2) acknowledged before a notary public.

19


ALTERNATIVE NO. 1 STATEMENT OF WITNESSES I declare under penalty of perjury under the laws of California (1) that the individual who signed or acknowledged this advance health care directive is personally known to me, or that the individual’s identity was proven to me by convincing evidence, (2) that the individual signed or acknowledged this advance directive in my presence, (3) that the individual appears to be of sound mind and under no duress, fraud or undue influence, (4) that I am not a person appointed as an agent by this advance directive, and (5) that I am not the individual’s health care provider, an employee of the individual’s health care provider, the operator of a community care facility, an employee of an operator of a community care facility, the operator of a residential care facility for the elderly, nor an employee of an operator of a residential care facility for the elderly. First Witness: _________________________________________________________________ _______________________ (signature of witness) (date)

_________________________________________________________________ (printed name of witness)

(address)

(city)

(state)

(zip code)

Second Witness: _________________________________________________________________ _______________________ (signature of witness) (date)

_________________________________________________________________ (printed name of witness)

(address)

(city)

(state)

(zip code)

ADDITIONAL WITNESS STATEMENT I further declare under penalty of perjury under the laws of California that I am not related to the individual executing this advance health care directive by blood, marriage, or adoption, and, to the best of my knowledge, I am not entitled to any part of the individual’s estate upon his or her death under a will now existing or by operation of law. _________________________________________________________________ _______________________ (signature of witness) (date)

___________________________________________ (printed name of witness)

(address)

(city)

(state)

20

(zip code)


ALTERNATIVE NO. 2: NOTARY PUBLIC State of California ) ) SS. County of ___________________) On _____________________ before me,_______________________________ (insert name of notary public)

personally appeared _______________________________________________, (insert the name of principal)

personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same in his/her authorized capacity and that by his/her signature on the instrument the person upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. NOTARY SEAL ________________________________________________ (signature of notary)

STATEMENT OF PATIENT ADVOCATE OR OMBUDSMAN I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsman as designated by the State Department of Aging and that I am serving as witness as required by section 4675 of the Probate Code. _________________________________________________________________ _______________________ (signature) (date)

___________________________________________ (printed name)

(address)

(city)

(state)

21

(zip code)


Checklist of Things To Do NOTIFY:

DECIDE ON:

1) The Doctor or Coroner 2) The Funeral Director, Arrangement Director & Advance Planning Counselor 3) The Cemetery or Memorial Park 4) The Minister and Church 5) All the Relatives 6) All the Friends 7) Employer of Deceased 8) Employers of mourners who must be absent from work 9) Organist & Singer 10) Pallbearers 11) Insurance Agents: Life, Health, Accident, Etc. 12) Unions and Fraternal Organizations 13) Newspapers (notices & obituaries) 14) Attorney, Accountant or Executor of Estate

24) Cemetery/Mausoleum Property 25) Cremation Society: Direct, Ground, Niche, Etc. 26) Memorial or Monument 27) Casket 28) Vault or Outer Case 29) Clothing 30) Flowers 31) Music 32) Food 33) Information for Obituary 34) Time and Place of Service; Religious, Fraternal or Military 35) Transportation and Transportation for Family & Friends 36) Cards of Thanks

AND YOU MUST PAY FOR SOME OR ALL OF THE FOLLOWING:

IN ADDITION TO:

37) Doctors and Nurses 38) Hospital 39) Medicine & Drugs 40) Funeral 41) Cemetery Lot 42) Interment Service 43) Minister 44) Musical Selections 45) Florist 46) Clothing 47) Transportation 48) Telephone and Telegram 49) Food 50) Memorial or Monument 51) Current or Urgent Bills (mortgage, taxes, etc.)

15) Providing vital statistics about the Deceased 16) Preparing and signing necessary papers 17) Providing addresses for all interested people who must be notified 18) Answering innumerable sympathetic phone calls, messages & letters 19) Meeting and talking with everyone about all details 20) Greeting all friends and relatives who call 21) Providing lodging for out-of-town guests 22) Preparing home for visitors 23) Planning funeral car list

22


Why others have pre-planned... To ensure their house is in order To ensure plans are made together instead of alone To ensure protection from emotional overspending To ensure against future inflation To ensure the availability of payment-plans to fit their budget To ensure peace of mind.


At Need Grief Confusion Heartache Stress Uncertainty Alone


Pre Need Economic Secure Peace of Mind Together


Dignity of the Ages


Affordable, Clean and Dry


“God gave us memory so that we might have roses in December.” — J.M. BARRIE


Members of the Cypress Lawn Family:

Cypress Lawn Funeral Home 1370 El Camino Real Colma, CA 94014-3239 (650) 550-8817 (650) 755-0580 www.cypresslawn.com FD# 1797

Crosby-N. Gray & Co. 2 Park Road Burlingame, CA 94010-4404 (650) 342-6617 www.crosby-ngray.com FD# 96

Miller-Dutra Coastside Chapel 645 Kelly Ave. Half Moon Bay, CA 94019-1957 (650) 726-4474 www.millerdutra.com FD# 40

Sneider Sullivan O’Connell 977 South El Camino Real San Mateo, CA 94402-2346 (650) 343-1804 www.ssofunerals.com FD# 230


Cypress Lawn Estate Planning Guide  

This guide is a useful and practical place to record vital personal and financial information that will one day be needed; give yourself and...

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