• • Date * Today's date
    
    
• • Name
    
    First
    
    Last
• • Address
    
    Street Address
    
    Other Address (optional)
    
    City
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    Zip/Postal Code
    
    Region (optional)
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• • Email
    
    
• • Persons to notify: Pastor
    
    First
    
    Last
• • Persons to notify: Doctor
    
    First
    
    Last
• • Persons to notify: Funeral Home
    
    First
    
    Last
• • Persons to notify: Executor of Will
    
    First
    
    Last

• • Funeral Plan

    List here all the details for the funeral
• • Mortuary being used (if any)
    
    Please include any arrangements with funeral director
• • Do you want a visitation the night before the funeral service?
    Yes
    No
    
• • Do you want:
    Funeral with casket or urn present
    Memorial service without casket or urn
    
• • Do you want the funeral service conducted at:
    Westwood Lutheran Church
    Chapel in the mortuary
    Other
    
• • Please list music preferences
    
    Include favorite hymns, solos and musician requests
• • Scripture passages you want read
    
    Include up to two passages and one Gospel reading

• • Preference for disposition:

    List here all the details for disposition of the body
• • Autopsy?
    Yes
    No
    
• • Traditional burial at cemetery?
    Yes
    No
    
• • Cemetery, mausoleum or columbarium name
    
    Please give name of cemetery, city and state
• • Cremation?
    Yes
    No
    
• • Private burial or inurnment?
    Yes
    No
    
• • Pallbearer names and numbers
    
    

• • Memorials

    Please list all preferences for memorial monies
• • Memorials to:
    Westwood Lutheran Church
    Westwood Lutheran Memorial Foundation
    
• • Have you made a will?
    Yes
    No
    
• • Where is your will located?
    
    Be sure to tell family or friend where it is
• • Have you made a living will?
    Yes
    No
    
• • Where is your living will located?
    
    Be sure to tell family or friend where it is
• • Lawyer's name and contact information
    
    
• • Any other information or requests?
    
    

• • Biographical information

    You may want to make a list of other important numbers and records and keep it in a private place for family use.
• • Birthdate and place of birth:
    
    
• • Father's name, birthdate and place of birth:
    
    
• • Mother's name, birthdate and place of birth:
    
    
• • Date you were baptized (if applicable):
    
    Include church name and location
• • Date you were confirmed (if applicable)
    
    Include church name and location
• • Date and place of marriage (if applicable):
    
    Include church name and location
• • Other information to be included in obituary:
    
    

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