Why You Need a Funeral Plan Your NameDate of BirthYour AddressHome PhoneMobile PhoneEmailSocial Security Number Who will be your agent responsible to make sure your funeral wishes are followed?Their NameTheir AddressHome PhoneMobile PhoneTheir EmailDo you need an agent for Body Disposition form?YesNoAre you a Veteran?YesNoPart OneHow do you want your body to be taken care of (check one)?Conventional cemetery burialGreen cemetery burialCremationWhole body donation to scienceBody organ donation through C.O.R.EBurial At SeaOtherIf Conventional or Green burial, Please enter Cemetery NameIf Body donation to science, Please enter Organization NameIf Other, Please DescribePart TwoFuneral Home NameFuneral Home AddressORMy family can choose the funeral home when I die, but I don’t want them to spend more than $__________ in funeral home charges.Amount From AboveFuneral home services I want (check all that you would like): Embalming Viewing Visitation Burial container: (see below) Memorial service at the funeral home (Note: services elsewhere are covered in Part 3 below.) Newspaper obituary Special burial clothing. Other. If Burial Container (Select all that apply) Coffin Shroud Do not spend more than $ ____________ on my burial container. Amount Limit for Burial ContainerIf Special Burial Clothing, Please DescribeIf Other, Please DescribePart ThreeService. (Check all that you would like): Religious service Non-religious service Graveside service Clergy person or officiant: Eulogy or sermon Songs: Readings: Other: If Religious or Non-Religious Service, Where will it be atIf Clergy or Officiant, Describe WhoIf Songs, Please list songs you want playedIf Readings, Please list what you want readIf Other, Please DescribePart FourPayment. (Check all that apply): Life Insurance: Funeral trust: Other If Life Insurance, What is Company NameIf Life insurance, What is Your Policy NumberIf Funeral Trust, Bank NameIf Funeral Trust, Account NumberIf Other, Please Describe