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) __________________________________________________________________ __________________________________________________________________ 3/23/2016 Page 1 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 __________________________________________________________________ 3/23/2016 Page 2 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 ___ 3/23/2016 Page 3 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. 3/23/2016 Page 4 ________________________________________________________________ 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? ___________________________________________________________________ 3/23/2016 Page 5 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. 3/23/2016 Page 6 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). 3/23/2016 Page 7 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. 3/23/2016 Page 8