The Christian Memorial
(A working document for a responsible Christian approach to death)
Grace Community Church of Falcon, CO
Dr. Pat Jeffrey
Rev. Bill Clarke
Dr. Dick Glasgow
Pastor's note:
This paper is merely a working tool and not a "legal" document. In no way does it take
the place of a “will”. It has been designed for your use in order that you and your family
might prepare in a deliberate way for the reality of physical death. It also provides you
with some choices to make ahead of time that will make it easier for your loved ones.
Take a moment and discuss the options with your family. Use my message of January
11, 2015 (which is on the web site) as a theological background, and attempt to make some
choices for yourself that will make an eternal statement about your relationship with the
Lord, Jesus Christ. If you do not make your requests known, your family will undoubtedly
be tied by tradition, and many of our traditions surrounding death and funerals are more
worldly than they are Christian. Hopefully, we as Christ's people can begin to change our
traditions so that we can glorify and lift up the name of Jesus Christ even in our passing.
Look over these papers and fill them out soon! The “family information” and
“financial information” are for your use to make things easier to find for your family.
Make copies of these for your family and store in a prominent desk drawer (outside your
lockbox). The Memorial wishes sheet is to be filed with the church office, so that we can
help guide your family during a time when grief and other emotions make it hard to make
any decisions. It is always hard for us to think about our own physical death, but do it
because you love your family.
Remember that the life offered us by Jesus Christ does not end at the grave. Ask
yourself why things are done as they are at the time of a funeral. Then let your passing
into the presence of the King be more than traditional. Let it be a witness to the
resurrection of God's Son and the resurrection of those of us who have already accepted the
invitation to join Him in eternity.
Memorial Wishes of ____________________________________
(This sheet is for the Church; please make additional copies for family and funeral director)
Funeral Home desired: _______________________________________________________________________
Address & Phone No. of Funeral Home: _________________________________________________________
__________________________________________________________________________________________
Burial ( ), Cremation ( ), Donated to Science ( ): (specify)
__________________________________________________________________________________________
Organ Donation Agreement: ___________________________________________________________________
Name of Cemetery: __________________________________________________________________________
Lots Purchased: yes ( ), no ( ). Lot location: ____________________________________________________
Public visitation: yes ( ), no ( ), doesn't matter ( ). What you want to wear if in a casket: _________________
___________________________________________________________________________________________.
If present, casket open before service: yes ( ), no ( ) -- Casket always remains closed after service.
Price range of casket to be chosen: Expensive ( ), Midrange ( ), Inexpensive with any extra money going to living
memorials ( ).
Explain_______________________________________________________________________________________________.
Memorial gifts only ( ), Flowers only ( ), Family flowers and friends’ memorials ( ).
Memorials desired for: 1._________________________________, 2.___________________________________.
Location of service: Funeral Home ( ), God's House -- the church ( ).
Which of the following do you want: ( ) 1. Traditional funeral order, ( ) 2. Family service & interment of body,
then memorial service with the worshipping community to focus on resurrection. ( ) 3. Other - (specify)
____________________________________________________________________________________________.
Suggested Scriptures to be read: ___________________________________________________________________
Suggested Poems or readings: _____________________________________________________________________
Hymns to be sung or played (specify which): _________________________________________________________
_____________________________________________________________________________________________
Hymns or Praise songs to be sung or played ( ) or congregational singing ( ) Number of songs (
)
Service Organizations involved: yes ( ), no ( ). If yes, when? -- night before at funeral home ( ) or at cemetery ( )
Name of organization ___________________________________________________________________________
Obituary to be: ( ) Found where? _________________________________________________________________
( ) Printed in papers - (specify) __________________________________________________________________
___________________________________________________________________________________________
( ) Printed on memorial folder ( ) Used as material for memorial service
Something you definitely don't want: _______________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________.
Special wishes: _________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________.
Pastor's name: (Usually the present, resident pastor) __________________________________________________________
Other pastor(s) or persons to assist: __________________________________________________________________
Date filed with church: ______________________
Signed: _____________________________________
Page 1
VITAL INFORMATION IN CASE OF DEATH
To Be Given to Family Members
Today's Date _____________________
Name:_________________________________________________________________________________
(First)
(Middle)
(Maiden)
(Last)
Social Security Number:__________________________________________________________________
Medicare and Medicaid Number:___________________________________________________________
Address:_______________________________________________________________________________
(street)
(town)
(zip code)
Date of Birth:________________________ Where Born-County:_________________________________
Resident of what State: ___________________Citizen of what Country:___________________________
Married ( ) , Never married ( ), Widowed ( ), Divorced ( ) (specify)
Married to: ____________________________________________________________________________
(give wife’s maiden name)
Place of marriage:_______________________________________________________________________
(location) (city)
(state)
(date)
Date of marriage:_______________________________________________________________________
Father's full name:_______________________________________________________________________
Mother's full name (include maiden name):___________________________________________________
Relatives' Names and Addresses and Phone Numbers (also note relationships):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Immediate Family Members deceased, dates, and relationship:
_______________________________________________________________________________________
_______________________________________________________________________________________
Page 2
Special Friends you want notified: (include address and phone number)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Education:______________________________________________________________________________
_______________________________________________________________________________________
Usual Occupation:_______________________________________________________________________
(give kind of work done during most of working life' even if retired)
_______________________________________________________________________________________
History of Life’s work & service (continue on back):_____________________________________________
_______________________________________________________________________________________
Armed Forces Service:___________________________________________________________________
(dates, places stationed, and serial number)
Date when you came to this community:___________________________________________________
Church and Service Groups:________________________________________________________________
_______________________________________________________________________________________
Name & Relationship of Next of Kin:_________________________________________________________
Address and Phone Number:_____________________________________________________________
Present Minister’s Name:________________________________________________________________
Minister's Address & Phone No.:__________________________________________________________
Name of Funeral Director Desired:________________________________________________________
Address & Phone No.:___________________________________________________________________
Is a Funeral plan already purchased: ( )Yes
( ) no _______________________________________
Stone purchased: ( )Yes
( ) no where? ________________________________________________
Attorney's Name:_______________________________________________________________________
Address & Phone No.:___________________________________________________________________
Doctor's Name:_________________________________________________________________________
Address & Phone No.:___________________________________________________________________
Pallbearers Desired:_____________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Page 3
FINANCIAL INFORMATION
(to help family in closing affairs)
Insurance Policies: (Life, Health, Burial, Hospital -- specify kind, amount, policy #, date)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Investments: (Stocks, Bonds, etc. - date entered here)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Bank Accounts: (Where and kind of account - date entered here)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Will: (Where located and date):_____________________________________________________________
Obligations: (Loans outstanding -- date entered here when obligations will be paid) ____________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Property Owned: (Specify location, real estate, and land) _________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Lease and Rental Agreements:_______________________________________________________________
_______________________________________________________________________________________
Safety Deposit Box (where located):__________________________________________________________
Other Financial Information Which Might Be Useful:____________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
page 4
DISTRIBUTION OF SPECIAL ITEMS
DATE ____________________
I wish the following people to have these special items of my estate:
Initial_________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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page 5