This document includes my final wishes and important information
TO MY FAMILY
Dear Loved Ones,
I recognize that this earth is not our final resting place and that we all will die one day. With that said, I feel that it is only fair to you that I take the responsibility of providing you with my desires and the necessary information in order to make arrangements for me when God calls me to my final resting place.
I have completed “My Exit Plan”, which includes the information that will be needed upon my death. I ask that you review and submit this document to the person that will be coordinating my arrangements. Additionally, I ask that you honor, respect and allow the designated person to enforce my decisions as stated in this document.
Please note that I have asked the three persons listed below to witness my signature on this document to indicate that I, in-fact, did execute this document in their presence. Further, although it is recommended, this document does not have to be notarized to be accepted as a legal and binding document.
I pray that “My Exit Plan” will provide comfort and relieve you of the stress of having to spend countless hours searching for information that will be needed.
With Love,
Name (print):
Signature:
MY PERSONAL INFORMATION
Full Name: First Middle_____ Last Maiden Generation (Jr., Sr. III) Title
Date of Birth Place of Birth ________________________Gender
Home Address City State Zip Code
Phone Numbers: Home Work Cell
Marital Status: Single Married Widowed Divorced Separated (Date) (Date) (Date)
Spouse’s Full Name: First Middle______ Last
Social Security Number Spouse’s Social Security Number
Currently Working, Retired or Disabled _____Occupation
Employer Phone Number
Address of Employer City State Zip Code
Military History: Branch of Service Name of War
Date Enlisted Location Service Number___________________
Date Discharged _____________Location Type of Discharge
Location of Military Records (DD214)
Spouse’s Military History: Branch of Service Name of War
Date Enlisted Location Service Number___________________
Date Discharged _____________Location Type of Discharge
Location of Military Records (DD214)
Father’s Full Name: First Middle________________ Last
Generation (Jr., Sr. III) Place of Birth Is he still living?
Home
Phone Numbers: Home Work Cell
If no, date of death Location of Burial (Cemetery)
Address _________________City State Zip Code
Mother’s Full Name: First Middle_______________ Last Maiden Place of Birth ________Is she still living?
Home Address City State Zip Code
Phone Numbers: Home Work Cell
If no, date of death Location of Burial (Cemetery)
MY PERSONAL DOCUMENTS
A copy of my Last Will & Testament has been given to
Address City State Zip Code
Phone Numbers: Home Work Cell
My Birth Certificate and all other important papers are stored Located at Address City State Zip Code
& Accounts
Account Credit Union Account
My Safe Deposit Box is located at
My Attorney is_____________
Address City State Zip Code
I have appointed to be the executor of my estate.
Address City State Zip Code
Phone Numbers: Home Work Cell
I have appointed to be the guardian of my children.
Address City State Zip Code
Phone Numbers: Home Work Cell
PERSONS TO NOTIFY
The following persons should be notified upon my death.
MY FUNERAL HOME & BURIAL INSTRUCTIONS
Funeral Home _________Phone Number
Address City State Zip Code
My decision to have a service: Yes No
Viewing & Service (Embalmed)
Open Casket Closed Casket Direct Cremation Viewing, then Cremation
Viewing: With Glasses With Jewelry Burial: With Glasses With Jewelry
My desire is to be cremated, which I have expressed in my own words below:
Casket Selection_______ Color
Desired Clothing New____ From Your Wardrobe_______
Type of Burial: Below Ground Above Ground Mausoleum
Do you own a plot or has a plot been designated for you by someone else? Yes No
Name of Owner Phone Numbers: Home Work Cell
Address of Owner City State Zip Code
Cemetery Phone Number
Address of Cemetery City State Zip Code
Section Lot Block
Out of state burial: Receiving Funeral Home Phone Number
Address City State Zip Code
HOMEGOING SERVICE INSTRUCTIONS
Name of Church _______Phone Number
Address City State Zip Code
Eulogist________________ 2nd Choice
Scriptures: Old Testament New Testament
Read By: Old Testament New Testament
Prayer Acknowledgements____
Choir or Soloist (1)______________
Choir or Soloist (2)
Song Selection (1) Song Selection (2)
Tributes (poems, etc.) (1) (2)
Remarks (1) (2) (3) Pall Bearers (1)
Honorary Pall Bearers (1)
Special Requests
Repast: Church/Home/Banquet Hall/Do not wish to have one
MY OBITUARY
Below are the persons that I want to be listed in the newspaper:
Spouse Children Stepchildren Parents Stepparents Siblings
