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Personal Diary:
Please note: Do not place this
personal diary in a safety deposit box as it may be sealed until after your
funeral/burial arrangements have been carried out. For additional assistance,
please contact Maple Grove Cemetery staff.
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To my
family and friends:
After
careful thought, I have completed this diary with specific information,
expressing my preferences on a variety of subjects related to my funeral and
burial arrangements. Unless changed by unexpected circumstances, I desire and
request that you honor these preferences.
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Signed: |
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Date: |
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PERSONAL INFORMATION:
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Name:
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Address:
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City:
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State:
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Zip:
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Date of Birth:
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Place of Birth |
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City:
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State:
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Zip:
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Occupation:
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Employer: (or retired ?)
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Name of Spouse:
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Father's Name/Place of Birth/Year:
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Mother's Maiden Name/Place of Birth/Year:
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Names/Addresses of Children:
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Social Security Number:
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Military Service: |
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Branch Rank:
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Date of Enlistment:
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Date of Discharge:
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Serial Number:
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Fraternal, Service, Union Memberships:
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Relatives/Freinds to Notify:
(Name/Relationship/Address/Telephone of each)
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LOCATION OF IMPORTANT DOCUMENTS: |
Will:
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Cemetery Deed:
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Insurance Policy(ies):
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Safe Deposit Box/Keys:
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Bank Accounts:
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Real Estate Deed(s):
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Birth and Marriage Certificates:
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Stocks and Bonds:
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Mortgage(s):
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FUNERAL PREFERENCES: |
Funeral Director:
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Funeral Home/Address/State:
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Prearrangement Contract Location:
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Clergy:
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Location of Funeral:
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Type of Funeral (Military,
Fraternal, Religious, Humanistic, Other):
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Pallbearers:
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Special Requests:
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