A Personal Guide for Your Family and Loved Ones
We suggest completing the following record and filing a copy with
Baskwill Funeral Home.
In the event of death, this information will be extremely helpful.
There is no cost involved in doing this.
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| Full Name:* |
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| Residence: |
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| City: |
State: Zip: |
| Phone: |
Email:* |
| Name of person submitting this information:* |
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| Marital Status: |
Single Married Widowed Divorced |
| Husband or Wife of: |
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| Date of Birth: |
Birthplace: |
| Education (highest level): |
Elementary/Secondary
College
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| High School Attended: |
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| College(s) Attended: |
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| Name of Father: |
Father's Birthplace: |
| Mother's Maiden Name: |
Mother's Birthplace: |
| If Veteran, give branch: |
Rank: |
| Next of Kin: |
Relationship: |
| Address: |
Phone: |
Family:
(survivors, their spouses & their places of residence) |
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Length of Residence:
(give name of town and number of years in residence) |
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| Date of Anniversary: |
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| Number of Years Married: |
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| Employment: |
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| Date of Retirement: |
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Organizations:
(hobbies, travels, interests, clubs, memberships) |
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Personal Attributes/Accomplishments:
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| Memorial Contributions or Donations should go to: |
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| Executed copy of this instrument is held by: (name of relative, friend or institution) |
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| Address: |
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| City: |
State: Zip: |
| Phone: |
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PERSONAL WISHES & DESIRES
This is information families never discuss - especially the children. But yet, if something had happened to you last night, these are the questions your funeral director would be asking your family today. |
| Would you have had your service: |
at the funeral home
at the church other |
| What is the name of your church or synagogue? |
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| Who's your favorite minister, priest or rabbi? |
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| Are there any readings or scriptures that are special to you? |
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| Many people have a favorite song or hymn. What's yours? |
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| Some families prefer a memorial donation instead of flowers. What is your feeling? |
Memorial Donation Flowers Both |
| What clothing would you prefer? |
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| Would you like to wear jewelry? |
Yes No |
| To be removed? |
Yes No |
| Would you like to wear your eyeglasses? |
Yes No |
| Do you have cemetery property? |
Yes No |
| If yes, provide Cemetery Name, Location, Plot# and Space#. |
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| Most families prefer to have friends, neighbors, or relatives serve as pallbearers. Who would you prefer? |
Active Pallbearers (names & phone numbers)
Honorary Pallbearers (names & phone numbers)
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