My Funeral Rough Draft

My Funeral Rough Draft: Personal Data and Final Arrangements Forms
A complimentary planning tool from


You won’t be around to see the final edition of your own funeral, but you have a chance to write the rough draft (instead of leaving it to someone else).

In fact, completing this document is the easiest and most important first step you can take, to compile all of the information needed when a death occurs, to help your survivors during the difficult days after you die, and to ensure that your funeral follows your wishes.

After you have completed this Draft, the next funeral planning stages to consider – the “revisions” if you will – are:
-line up the companies that will do the necessary work, to take care of your body, ceremonies and memorials;
-and put some money aside if that is your desire.

But if you don’t do anything else about your final arrangements, completing this document can make all the difference.

-Complete one form for each person
-If arrangement information is duplicated for a spouse or other relative, you can complete partial forms for the other person and keep the forms together. But each person needs to have their own complete “Vital Statistics Data” in Section 1, for the death certificate. A small portion of Vital Statistics Data will be used for the obituary.
-If printing and filling out, be sure to use extra pieces of paper if needed, in order to provide complete information.
-Put this information in an envelop or folder, and make sure someone knows where to find it when death occurs.

-Never include full birth date or current address of deceased in obituaries.
-Withhold maiden names and last names of people listed in obituary, wherever possible.
-Follow the rule: It’s a story, not a historical record. The less detail about other people, the better. Err on the side of less information.

-Complete to the best of your ability: The more information you can include here in advance, the easier it will be for survivors.
-Most of the information in this section is needed solely for the death certificate, although some is needed for purposes not related to the death certificate, such as applying for benefits, completing the obituary, next of kin contact for body identification if applicable, and making funeral arrangements.

Legal Name (first, middle, last):
Name on Birth Certificate (if different):
Nickname and/or AKA (if any):
Street Address:

Inside city limits? (yes or no):

Birth Date (month, day, year):
Birth Place (city and state, or foreign country):
Social Security Number:
Race – indicate which of the following:
__Black or African American
__American Indian or Alaska Native
__Asian Indian
(Name of the enrolled or principal tribe) _______________
__Other Asian (Specify)__________________________________________
__Native Hawaiian
__Guamanian or Chamorro
__Other Pacific Islander (Specify)_________________________________
__Other (Specify)_______________________

Hispanic Origin? (yes or no):
If yes, indicate which of the following:
__Yes, Mexican, Mexican American, Chicano
__Yes, Puerto Rican
__Yes, Cuban
__Yes, other Spanish/Hispanic/Latino
(Specify) __________________________

Education (highest degree or level completed):
Schools Attended:

Main Occupation and/or Job Title (when working):
Years Employed:
Type of Industry or Business:
Retirement Date:

Military Service? (yes or no):
Branch of Service:
Enlistment Date:
Served or Stationed at:
Rank at Time of Discharge:
Discharge Date:
Discharge Papers Location:
Eligible for Veteran’s Disability (yes or no):

Marital Status (single, married, widowed, separated, divorced):
Marriage Date and Location:

Spouse’s Full Name:
Spouse’s Full Name Prior to First Marriage (if different):
Spouse’s Address and Phone Number:

Father’s Full Name:
Father’s Birth Place (city/state, or foreign country):
Father’s Address and Phone Number:

Mother’s Full Name Prior to First Marriage:
Mother’s Birth Place (city/state, or foreign country):
Mother’s Address and Phone Number (if different):

Informant’s Name (Person responsible for providing above information at time of death. This information may not be known until a death has occurred.):
Informant Address:

Informant Phone Number:
Informant Email Address:
Informant – Relation To Deceased:

[This section to be completed only after death has occurred. Medical personnel may be able to assist if needed.]

Date of Death:
Location of Death (county or city, and state; or foreign country):

Facility name and address where death occurred, if applicable:

If death occurred in a hospital, indicate decedent’s status:
__Emergency room/Outpatient
__Dead on Arrival.

If death occurred somewhere other than a hospital, indicate which of following:
__Hospice facility
__Decedent’s home
__Nursing home/Long term care facility
__Other (please specify):

Age at last birthday (if under one year, provide months and days):

Attending Physician or Coroner/Medical Examiner Name:
Attending Physician or Coroner/Medical Examiner Address:

Attending Physician or Coroner/Medical Examiner Phone:
Attending Physician or Coroner/Medical Examiner Fax:

Method of Disposition – indicate which of the following:
__Removal from state
__Other (please specify):

Place of Disposition (name and address of cemetery, crematory, or other place):

Funeral Facility name and address, if applicable:

-People whose information may be needed immediately after a death occurs.
-Complete to the best of your ability. If there are living children who are legal next of kin, their contact information may be mandatory at time of death.

Children – list with names, addresses, phone numbers, spouse names if applicable. Please indicate if any are deceased, and year of death:

Grandchildren – names:

Great Grandchildren – names:

Brothers, Sisters – list with names, addresses, phone numbers, spouse names if applicable. Please indicate if any are deceased, and year of death:

Executor (if applicable), name, address, phone number, email:

Designated Agent, or Next of Kin, for carrying out funeral arrangements (if applicable), name, address, phone number, email, and relationship to deceased:

Attorney (if applicable), name, address, phone number, email:

Physician(s), name, address, phone number:

Other Immediate Contacts (examples may be Employer, Insurance Agent, Accountant, Investment Advisor), name, address, phone number, email, and their position:

People Who Can Notify Others, name, phone number, email:
Place a list of people who will be able to help get the word out to others among your family, friends, and acquaintances. These are people who can spread the word, via telephone, email and social media, in addition to or in lieu of newspaper obituaries.

-This list will help survivors quickly locate the most critical information usually needed after a death occurs.
-Indicate which of the following you have, and where each can be located.
-If “Location” is at home, explain where. If at some other place, provide address, phone number and name of contact person if needed (such as attorney, relative, business associate, friend, etc.).


__Safe Deposit Box(es)
Location(s) (also indicate location of key):

__Burial and/or Funeral Plan Documents, Account Numbers (if applicable)
Location(s) and Descriptions:

__Insurance Certificates, Payment Receipts, Other Documentation

__Bank Account Statements, Checkbooks, Bank Books

__Other Financial Certificates and Documentation (list of stocks, bonds, bills of sale, loans, other assets and liabilities)

__Real Estate – Home and Other Property Documentation and Deeds

__Monthly Bills, Receipts

__All Other Official Documents (birth and marriage certificates, diplomas, military or government service documents, social security card, memberships, etc.)
Location(s) and Descriptions:

-Indicate any wishes or plans regarding your funeral-related services and disposition of your body.
-The more you can specify ahead of time, the easier it will be for your survivors.
-If a death has just occurred, the sections below will help you decide what to do next.
-Ideally, for your own prearrangements, you will eventually create a comprehensive set of instructions and supporting materials. The list below is a necessary first step for compiling the necessary information for your survivors.
-If you have already prearranged your final arrangements, this entire section may not be necessary – the required information may already be recorded in your plans for the portion(s) already prearranged.
-This section may be useful for recording information not specified in your other prearrangement documents.

__Check here if you have a person designated in Section 2 above as Agent or Next of Kin, to carry out your funeral wishes.

__Check here if you have purchased or otherwise prearranged a burial, cremation or funeral plan, with location of relevant documents indicated in Section 3 above.

Type of Disposition (select one of the following):
__Burial or Entombment (Cemetery)
__Body Donation and “Plan B”
If you have made arrangements to donate your body, provide full contact information for the recipient institution. You also should include full instructions for what should be done with your body afterwards, if/how you want your remains returned, what to do if for some reason your body cannot be donated – i.e., a Plan B – and what type of ceremony you envision. You should use a separate piece of paper if necessary, and use the sections below for the ceremony details. Plan B is very important because there are a lot of circumstances that can cause a body donation to fall through.

__Other (?)
Technically, there are a few other things you can do with a dead human body. Explain in detail your ideas, and provide contact information for any organization with which you have already made arrangements.

Ceremony Considerations
-To get the big picture view of the ceremonial/ritual aspect of your final arrangements, please answer a few questions. The answers will help you define your concept and decide the types of events you want.
-As noted above, the ceremonial part of the final arrangements can be a big deal, and it would be best for you to put together a package of information for your survivors to work from.

Consideration #1: Religious Traditions
If you participate in a religious or spiritual tradition with tenets about how end-of-life rituals should go, and you want to follow that tradition, then your first step should be to consult with clergy or other leaders who can explain the traditional rites. If you decide to follow a ritual structure already defined, then your funeral planning may have just gotten much simpler.

A few religions specify acceptable forms of bodily disposition, so you may need to learn about your tradition before making a final decision on the previous section.

Some religions prescribe exactly what must take place from the time the death occurs until bodily disposition is complete, including certain types of rites. Music, readings, speakers and topics allowed, and the order of events, may be completely or partially predetermined. At very least, for the structured portion(s), a pastor or other clergy can serve as “master of ceremonies” to guide the proceedings, if you wish.

Are you planning to follow a religious or spiritual tradition for your funeral and burial rituals? If so, please indicate A). the name of the religion, denomination, practice or other tradition; B). description of the ceremonial instructions or requirements you plan to follow – the name of the “order” or set of rules, if applicable (this may need to be a separate document); C). list of events from the following section that will incorporate these religious/spiritual elements; D). person from the tradition who will officiate at the ceremony or recommend an officiant, if applicable – name, address, phone and email address.

Consideration #2: Your Preference For Ceremonies
If you aren’t bound by religion, you can have anything you want to fulfill the ceremonial function of the funeral. Following are some ideas based on tradition.

Ceremonial Event(s) (select any, all, or none, of the following):
__Funeral/Memorial Service. A ceremony with some type of “program,” with a formal or semi-formal structure. In previous times, this type of event would almost always be held at a religious institution, or funeral home. Today, if the full body is not going to be present, the service can be held literally anywhere you have permission for a gathering. Even with a body present, the event might still be able to take place at home, if state laws and circumstances allow.
Please indicate A). with the body present, or not present; B). before disposal of the body, or afterwards; C). location(s) of event; D). how many of these events. (The norm is to have a single “funeral service” or “memorial service,” but you can have more than one to accommodate different groups of people.)

__Graveside service
Typically a brief, somewhat structured “committal” service, held just as a body is buried or entombed at a cemetery. You could also hold it when cremated remains are being interred at a cemetery or elsewhere. Historically as well as today, a graveside service can be the only service, and there is no rule that it has to be short. If the interment is outdoors, weather can be a factor. Please indicate any details about where, when, how, and use the sections below to fully describe the service.

__Visitation or “Wake.” Unstructured visit(s) with the bereaved.
In the conventional American funeral, this is where the preserved body is displayed and the family receives visitors in an informal manner, at the funeral home. There can be multiple visitations and in prior eras these might go on for days. Usually, nowadays, the visitation is comprised of one or two occasions of a couple hours each, the day before the funeral service. Often, people who cannot attend the funeral service will attend the visitation, as it provides another opportunity to pay respects, usually after working hours, in a busy society.

Please indicate A). with the body present, or not present; B). with the body on display, or in a closed casket; C). where the visitation should be held; D). when and how many times it should be held; E). anything else you would prefer for your visitation. Some possible variations: Depending on state laws and circumstances surrounding the death: visitation could be held at a home with the body present; there could be food and drink at the funeral home; it could be a veritable party; if the body is already cremated, or the body will not be present, the visitation could take place literally anywhere, with or without funeral director assistance; and if you really prefer informality, the “visitation” could be the sole ceremonial event. You don’t have to do anything more.

__Other Event. Mix and match from those above, or create your own.
Funeral rituals have changed over the past several thousand years, and they are still changing today. While you probably ought to hold some type of ceremony, there are no hard and fast rules. If none of the above seem appropriate, use the space below to describe the type of ceremony you prefer, and use an extra piece of paper if needed.

Ceremonial Content: Reading, music, participants, and anything else you would like to specify about the event(s)

Funeral and Crematory Information
Funeral Home/Mortuary or Crematory Name:
Contact Person:


Type of Disposition (burial, entombment, cremation, or body donation):

Name & Location of Cemetery/Mausoleum:

Description of Lot or Mausoleum:

-Here is where you fill in the details of your life, that may be relevant, and are not already covered above. Here is a short list to get you started – but this could be a very long section, that you fill in over time, and may require extra space. 

Religious Affiliation/Memberships
Religious Affiliations:
Church Groups/Membership:

Clubs/Lodge Memberships:

Professional Organizations:

Unions or Civic Group:


Additional Resources

If you’d like to look at other funeral planning forms, here are some to consider which are available either for download or purchase. The links are offered “as is” as a convenience to readers, but without any guarantee that the information is what you’ll be looking for. Many other funeral planners are available on the Internet if you do a Web search.

National Caregivers Library
End-of-Life planning forms

National Home Funeral Alliance
Planning Guide and Workbook for Home Funeral Families

Funeral Planning Basics

Karen Jones
Death for Beginners