Funeral Instructions

FUNERAL INSTRUCTIONS

A copy of the Personal Information and Funeral Service information should be placed on file at Calvary Church. Copies of these forms, along with the estate and financial information, should be given to family members and others as appropriate.

PERSONAL INFORMATION

Full Name______

Present Address______

______

Date of Birth______

Place of Birth ______

Father’s Full Name______

Living?______

Mother’s Full Name______

Living?______

Marital Status: __Single __Married __Partnered __Divorced __Widowed

Marriage Date (if appropriate)______

Name of Spouse/Partner______

If widowed, date of spouse’s death______

Children – names and place of residence

______

______

______

______

Grandchildren – names

______

______

______

______

Great-Grandchildren – names

______

______

______

Brothers and Sisters – names and places of residence

______

______

______

______

______

Schools attended – Degrees

______

______

______

Occupation ______

Retired? ______Date of retirement______

Other biographical information – organizations, interests, awards, etc.

______

______

______

______

MILITARY RECORD

Dates of Service______

Branch of service______

Service Number______

Location of discharge papers______

Persons to be contacted at the time of death – add pages if necessary to list relatives and

friends to be contacted, including names, relationship, address and phone number

______

______

______

______

______

______

______

______

______

______

______

FUNERAL SERVICE INFORMATION

Upon my death, the following should be notified:

Clergy of ______Church

Church Address and Phone______

______

______

Name/s of Clergy ______

Funeral Home______

Address______

______

Phone ______

Have you made funeral arrangements there?_____

Has your funeral been pre-paid? _____ Location of paperwork______

My family should receive guests

____At the funeral home

____At home

____At the church

____Other______

The coffin should be

____Open for family and then closed

____Closed

I prefer to be

____Buried

Coffin should be __Least expensive __Mid-range __ Elaborate

Place of interment______

Address______

Location of deed for cemetery plot, mausoleum, etc.______

____Cremated

__ Before funeral service __After funeral service

Disposition of ashes______

Location of columbarium contract______

Note: to make arrangements for a place in the Calvary Church columbarium,

please contact the church office.

____ Donate entire body

___Arrangements have been made with______

___Please make appropriate arrangements

Comments______

______

I request that my funeral service be

___Rite I (traditional language, BOOK OF COMMON PRAYER, p. 469)

___Rite II (contemporary language, BOOK OF COMMON PRAYR, p. 491)

___I would like the service to include the Eucharist (Holy Communion).

Scripture Readings and Psalms (see the BOOK OF COMMON PRAYER, p. 471–480 or p. 494-495)

Old Testament______

New Testament______

Gospel______

(A gospel reading is required when the service includes a celebration of the Eucharist.)

Psalm/s______

Prayers

______

______

Hymns

______

______

______

Other music

______

______

Other comments or requests concerning the service

______

______

______

______

Participants in the service

Readers ______

______

______

Speakers (if desired) ______

______

______

Pall Bearers

______

______

______

Ushers

______

______

______

Memorial Donations

In lieu of flowers, I request that donations be made in my memory to:

______

______

______

Additional information or instructions

______

______

______

______

Estate and Financial Information

Social Security Number______

Insurance information – company, policy number, location of policy

______

______

______

Safe deposit box – location, box number, and location of keys

______

______

Other financial information – bank accounts, stocks, real estate titles, automobile titles, etc.

______

______

______

______

______

Will – location, executor of estate

______

Location of other personal information for survivors

______

Calvary Episcopal Church | 315 Shady Avenue, Pittsburgh, PA 15206 | 412.661.0120

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