End of Life

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 #_________________

______________________________________________Contact #_________________

______________________________________________Contact #_________________

______________________________________________Contact #_________________

______________________________________________Contact #_________________

______________________________________________Contact #_________________

OR

     Cremation_______ Designated Organization___________________________________________________

       _____________________________________________________________________________

     Contact Information:  (          ) ___________________________________________________

     Designated Recipient of Cremains: _______________________________________________

     Relationship:  ____________________________ Phone # (         ) _______________________

OR

     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

_______________________________________________________/_____________________
Witness Signature / Date


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