End of Life - Unitarian Universalist Church of Tampa

LEGACY PLANNING FORM

In late 2014, a Legacy Planning workshop was held and was open to all UUCT members.

The workshop covered many end-of-life issues including:

Required health directives
Financial and legal considerations
Legacy planning
Choices for final arrangements

UUCT members may want to be aware of a form to help individuals designate what end-of-life decisions they have made, how they want them carried out, and their choices regarding a memorial service. The form appears below.

The document is entitled Personal Planning Information for End of Life. When the time comes, this form will prove helpful to people carrying out a UUCT member’s final wishes about a celebration-of-life service and any final disposition of remains and resting place directives.

To fill out your form, simply print this page. It is a good idea to give a copy to your designated representative and to keep a copy for yourself.

Unitarian Universalist Church of Tampa

PERSONAL PLANNING INFORMATION FOR END OF LIFE

(PLEASE PRINT)

Member Name: _____________________________________________________________________

Home Address:

___________________________________________________________________________________

Phone # ( ) ________________________ E-mail ________________________________________

Primary Contact: ______________________________________________________________________

Relationship: __________________________________ Phone # ( ) _____________________

Obituary Author: __________________________________ Phone # ( ) _____________________

The following are my choices for final arrangements on my behalf:

Traditional Burial ______ Funeral Home in Charge::_____________________________________________

___________________________________________________________________________________

Contact Information: ( ) __________________________________________________________

Designated Burial Site _______________________________________________________________

Graveside Service: Yes ____ No____

Pallbearers:

______________________________________________Contact #_________________

Cremation_______ Designated Organization___________________________________________________

_____________________________________________________________________________

Contact Information: ( ) ___________________________________________________

Designated Recipient of Cremains: _______________________________________________

Relationship: ____________________________ Phone # ( ) _______________________

Donation of Remains to Science: _____ Designated Organization:

___________________________________________________________________________________

Contact Information: ( ) ________________________________________________________

The following are my choices regarding a Memorial Service:

Location: Church _____ Funeral Home _____ Other _____________________________________________

To Officiate: __________________________________________________________________________

Participating Organization/s: Military____________ Fraternal____________ Other_______________

Music and other elements I would like included:

Hymns:

___________________________________________________________________________________

Other Music – Solo, Choir, Instrumental, Recordings:

___________________________________________________________________________________

Readings:

___________________________________________________________________________________

Poems:

___________________________________________________________________________________

Special Presentations, Performances, or Exhibits

___________________________________________________________________________________

Memorial Donations should be directed to the following: ___________________________________________________________________________________

___________________________________________________________________________________

Following the service I prefer for family, friends, and guests:

A reception with refreshments and food to be served:

At the church _____

At my home _____

Alternate location __________________________________________________________________

These are my wishes and directives written this _____ day of _______________, 20____.

_______________________________________________________
Member Signature

_______________________________________________________/_____________________
Witness Signature / Date

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