Trinity Church, Myrtle Beach, SC
End of Life Wishes Form
Print Your Name ____________________________________________
Life is fragile. None of us knows when we are going to die. So it is important that
you prepare for your family in advance for this difficult time. We have made up
this form to help you write down important information and your wishes.
General Information
This information will be helpful to the person(s) who will help write up your
obituary.
Legal Name ________________________________________________________
Nickname _____________________Maiden Name ________________________
Current Address ____________________________________________________
Phone Number _____________________________________________________
Birth Date _________________________________________________________
Occupation ________________________________________________________
Education _________________________________________________________
Military Service:
Branch Name ___________________________________
Years Served __________________
Decorations_______________________________________________________
Organizations Belong to and positions held (past and present)
__________________________________________________________________
__________________________________________________________________
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Awards and Honors:
___________________________________________________________________
Hobbies ____________________________________________________________
__________________________________________________________________
Special Accomplishments ______________________________________________
___________________________________________________________________
Anything not mentioned you would like reported.
___________________________________________________________________
___________________________________________________________________
Marital Status M or S or D
Date of Marriage ___________________
Spouse’s Name
__________________________________________________________________
Names of Living Children
___________________________________________________________________
Names of living Grandchildren
___________________________________________________________________
Names of Other significant living relatives
__________________________________________________________________
Family Members who died before you
__________________________________________________________________
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People generally like to give flowers, what are your favorite kind and/or color(s)
Kind(s) _______________________ Color(s) ____________________________
Maybe you would rather have people give Donation(s) in lieu of flowers. If so,
where would you like these donations to go:
Name __________________________________ Phone # __________________
Name __________________________________ Phone # __________________
Name __________________________________ Phone # __________________
Name __________________________________ Phone # __________________
Please consider Trinity Church and/or Foundation.
Last Will and Testament
It is important that you have a written last will and testament. A will is a legal
document that describes your wishes as to whom your property is to be given. It
can be from a favorite watch, to real estate, stocks, oil rights, businesses, cash,
etc. It can be given to individuals, put into a trust account that would be
managed and administrated by a bank, lawyer, family member(s), or given to an
institution like a church. Trinity Church has the Foundation Fund to help keep the
proclamation of the gospel of Jesus Christ alive in Myrtle Beach and beyond. As
part of the will, an executor is named. The executor’s job is to collect all the
assets, pay the taxes and bills, and then distribute the remainder of the estate as
stated in the will. The executor has the legal right to take care of all the issues
related to the death of the person. Normally, a trusted family member is named
to do this but also the family member most often needs the help of a lawyer due
to the complex issues of settling an estate. The average estate settlement takes
over a year to complete. The wait is usually for clearance from the taxing
authorities.
Do you have a legal will? Yes ___ No ___
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If yes, who is the Executor(s):___________________________________________
Phone number(s):
______________________________________________________
What is the date of the will? ___________________________________________
Where is the original copy of the will held?
____________________________________________
Funeral Home
Have you have a contract or agreement with a funeral home? Yes___ No ___
If no, do you have a preferred funeral home? Yes ___ No ___
Funeral Home Name: _______________________________________________
Location: _____________________________________________
If not, we suggest that you do some research or if you have one you prefer,
contact them and set-up a meeting to tell them your wishes. Take along another
person with you. Don’t sign anything without talking it over with your family.
Ask about the savings if pre-paid.
Living Will/Organ Donation
Do you have a Living Will? Yes __ No ___
Does it contain a “Do Not Resuscitate” clause? Yes ___ No ___
Where is it kept? __________________
If no, see a lawyer about whether you want one or not. Many hospitals prefer
that you have one.
If you have legally agreed to donate an organ(s), please mark down the
organization where you made the agreement and the organ(s) you agreed to
donate.
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________________________________________________________________
Spiritual Needs Near Death
Do you want a pastor to come and pray with and for you? Yes ___ No _____
Do you want Holy Communion at this time? Yes ___ No ____
When bedridden, do you want Christian music played? Yes____ No___
When bedridden, do you want the Bible read to you? Yes____ No_____
Do you have preference as to which pastor you want to come? If so, please note.
______________________________________________.
Viewing or Wake Wishes
Part of the grieving process includes a viewing or wake. This gives people an
opportunity to express their condolences to your family and help them deal with
the reality of death. A person can have a viewing with the body and then be
cremated at an extra cost.
Do you have objections to having a viewing or wake? Yes ___ No ____
If no objections, would you like an open casket at your viewing or closed casket at
your wake? Circle either open or closed!
How many days for viewing do you prefer? One, two (norm) or three (please
circle one)
Do you have a preference as to what clothes/jewelry to be worn at viewing and
burial? If so, what are your wishes? _____________________________________
___________________________________________________________________
If possible, are there any persons who you would like as pall bearers? What are
their names?
___________________________________________________________________
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Burial Wishes
What:
I want my body buried. ____
I want my body to be cremated. ____
Where:
I wish to be buried at the following place:
______________________________________________________________
Above ground ____
In the ground ____
I own what I need. ____ Please attach on your copy the deed, receipt, etc.
If not owned, what are your wishes
__________________________________________________________________
__________________________________________________________________
In what:
I have purchased a casket for my body/urn for my ashes. _____
If not, what are your wishes? _________________________________________
_________________________________________________________________
When:
Do you wish to have your body or ashes buried/interred before or after the
church service? Circle before or after. Remember if before the service it will be a
Memorial Service.
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Service Instructions:
Traditional Christian burial services pages 469-507 of the Book of Common Prayer
takes place at the church with the body or ashes present. Immediately after the
service, the casket is usually taken to the cemetery for physical burial of the body
or ashes. The other choice is a memorial service. This is done either without the
body or ashes present or the ashes present. It is basically the same service.
I would like the traditional Christian burial service. ____
OR
I would like a memorial service. ____
Would you prefer to have only family and close friends at the church service or
one where the public is invited? Public____ Private____
The pastor is responsible for the design of the service. It would be helpful if you
note your wishes for your service.
Note your wish for the service to be at a different place than Trinity Church.
Name._____________________________________________________________
Address ____________________________________________________________
Name of the pastor who you want to do the service if other than the clergy of
Trinity Church. _________________________________________________
Contact information if other than a pastors at Trinity Church:
___________________________________________________________________
The pastor will select the Prayer Book rite unless you have a preference. My
preference is________________________________________________________
Rite I uses the traditional language (thy and thou) and Rite II uses
contemporary language (you and your).
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There will be Holy Eucharist unless you have a strong preference. No Eucharist
____ (please check).
The pastor will select the readings. If you would like to request any favorite
passages, please note them here:
__________________________________________________________________
The pastor will select the readers for the lessons. Do you have any one who you
would like the pastor to ask to read?
___________________________________________________________________
The Music Minister will select the Christian hymns and/or Songs to be sung or
played. Do you have any preferences? If so, please note them here.
__________________________________________________________________
Signature ___________________________________________
Date _______________________________
Keep this document with your other important papers and give a copy to Trinity
Church to be filed for your family and clergy. Give the parish a copy of this page
only.
We hope this document has been helpful to you in your planning.
God bless and we are here to answer any questions and concerns that you might
have.
See attached track, Preparing Spiritually for Death.
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