Rollins Funeral Home Personal Planning Guide

This guide is intended for your personal use. You can print the guide and complete it at your convenience. Share your wishes with a family member or trusted friend. If you do not want to review the guide with a family member, at least let someone know where it can be located in the event of your death.   Once the guide is completed, click here.


Name:

Date:

Dear Loved Ones:

In the pages that follow, I've recorded my desires and preferences regarding decisions you'll be asked to make after my death. Please read through this entire document before making arrangements for my funeral.

Upon my death, I want to donate my organs as indicated:

____ Any needed organs or body parts

____ No Donation

____ Only those organs or body parts listed.

___________________________________
___________________________________
___________________________________

____ I have a Living Will (location)
___________________________________
___________________________________

Notification:

Please let all these people know of my death:
Spouse (telephone number)
___________________________________

Children (full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

Parents (names and telephone numbers)
___________________________________
___________________________________
___________________________________

Siblings (full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________

Friends (full names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

Business Associates (names and telephone numbers)
___________________________________
___________________________________
___________________________________
___________________________________

Place of Worship (include telephone number)
___________________________________
___________________________________

This is who I want to handle my funeral:

Funeral Director: ______________________________

Funeral Home: ______________________________

Address: ______________________________
______________________________
______________________________

Please ask these loved ones to be my pallbearers:

____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Details of my funeral:

Speaker

Location of Funeral

Location of Burial

I prefer:
____ Flowers
____ Tributes to (charity or organization)
____________________________________________
____________________________________________
____________________________________________

Favorite Music
____________________________________________
____________________________________________

Requested Readings
____________________________________________
____________________________________________

Burial Wardrobe and Jewelry
____________________________________________
____________________________________________

Preferred Style/Material for:
Casket _____________________________________

Burial Vault _________________________________

Last Will and Testament:

Here is where you can find my will:
____________________________________________
____________________________________________

Executor
____________________________________________

Phone
____________________________________________

Other Important Papers:

This list will help you locate documents necessary for settlement of my estate (birth certificate, marriage license, deeds, automobile titles, insurance policies, pension information, income tax records, banking records, bonds, securities, stock certificates, etc.)

Document/Location
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Location of Safety Deposit Key:
____________________________________________
____________________________________________

Obituary:
I've indicated here topics I would like included in my newspaper obituary:
Spouse
____________________________________________

Date/Place of Marriage
____________________________________________
____________________________________________

Children
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Other Survivors
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

My Address
____________________________________________
____________________________________________

Birth Date & Location
____________________________________________
____________________________________________

Education (schools & degrees)
____________________________________________
____________________________________________
____________________________________________

Military Service
____________________________________________
____________________________________________

Occupation
____________________________________________
____________________________________________

Achievements/Awards
____________________________________________
____________________________________________

Please also mention the following:
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Other Information:
The funeral director will need this when filling out my death certificate:
Date of Birth
____________________________________________

Place of Birth
____________________________________________

Social Security Number
____________________________________________

Usual Occupation
____________________________________________

Kind of Business/Industry
____________________________________________

Military Service
____________________________________________

Highest Level of Education Completed
____________________________________________

Father's Name (first, middle, last)
____________________________________________

Mother's Name (first, middle, last, maiden)
____________________________________________

Place of disposition (name of cemetery, crematory or other place)
____________________________________________