Transcription
dign i t y m emor i a l Personal Planning Guide
The celebrationof a lifetimebegins here.
having things in ordermeans gaining peace of mind.This planning guide was designed to help you recordand organize important information, personal thoughts andyour final wishes. Making final plans now is one of the mostthoughtful gifts you can give your family. And, when you plan ahead,your Dignity Memorial professionals can help you coordinateevery detail to create a personal, meaningful tribute.
TABLE OFcontentsImportant Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Your Legacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Genealogy/Family History . . . . . . . . . . . . . . . . . . . . . . . . . 6Service preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8–9Memorialization preferences . . . . . . . . . . . . . . . . . . 10–11Transportation & RelocationProtection Plan Information . . . . . . . . . . . . . . . . . . . . 12Organizations to contact . . . . . . . . . . . . . . . . . . . . . . . . 12People to Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Social Security Information . . . . . . . . . . . . . . . . . . . . . 14Military Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Estate Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15financial Information . . . . . . . . . . . . . . . . . . . . . . . . . 16–17Online Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18The Dignity Difference . . . . . . . . . . . . . . . . . . . . . . . . . . . 19final arrangement completion . . . . . . . . . . . . . . . . . . 20to my loved ones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22assisting family and friends . . . . . . . . . . . . . . . . . . . . . 23This Personal Planning Guide, when completed, will contain information of a confidential and private nature.For that reason, we recommend that you keep this guide in a safe, secure place where it can be accessed by your loved ones at a time of need.
IMPORTANT INFORMATIONNAME:FIRST MIDDLE LASTCONTACT INFORMATION:STREET ADDRESSCITY/COUNTYSTATEZIPEMAIL ADDRESS(ES)PHONE NUMBER(S)SEX:m Malem Female–SOCIAL SECURITY NUMBER:PLACE OF BIRTH:CITY/COUNTY STATE ZIPMARITAL STATUS:m Married – Date (MM/DD/YYYY)//–DATE OF BIRTH://m Never Marriedm Widowedm DivorcedNAME OF SURVIVING SPOUSE (MAIDEN NAME, IF WIFE)CAREER:OCCUPATION TYPE OF BUSINESS/INDUSTRYEMPLOYER PHONE NUMBEREDUCATION: (Highest grade completed) m Elementary/Secondary (0–12) m College (1–4 or 5 )COLLEGE/UNIVERSITY NAME(S) DEGREE(S)MILITARY SERVICE: Have you ever been a member of the armed forces? m Yes m No (If yes, complete ‘Military Service’ on p. 14)FATHER:FIRST NAME MIDDLE NAME LAST NAMEPLACE OF BIRTHMOTHER:FIRST NAME MIDDLE NAME MAIDEN NAMEPLACE OF BIRTHINFORMANT INFORMATION: (Person responsible for completing arrangements)NAMERELATIONSHIPSTREET ADDRESSSTATEEMAIL ADDRESS(ES)PHONE NUMBER(S)4Dignity Memorial CITY/COUNTYZIP
YOUR LEGACYMy fondest childhood memories:My earliest ambitions:Sharing your accomplishments,special memories and favoritethings will allow them to beremembered and cherished bygenerations to come.Things that make me smile:My proudest family moments:My proudest career accomplishments:Special achievements/awards/offices held/additional points of interest and memories:My favorite songs:My favorite color:Pastimes and hobbies I enjoy:Other favorite things:Personal Planning Guide5
GENEALOGY/FAMILY HISTORYThis page will serve as a reference andreminder of your unique lineage.family of:NAMEMy grandparents:My parents:My siblings:My spouse:My children:My grandchildren:6Dignity Memorial
No two of us are alike.Whether you live your life with a special flourish and pomp, or love to spendquiet moments enjoying a soft summer breeze, you are one of a kind.Your Dignity Memorial professionals understand this. It’s our honor tohelp you plan your life’s celebration to reflect your personality and passions.Maybe it includes the music you love, the food you grew up with,a treasured collection you’ve nurtured or a combination of many things.You set the stage and you decide. We’re here to see that your wishesare honored and that your special story is told.
SERVICE PREFERENCESA memorial service is a time for family and friends to gather and remember. When you planyour service in advance, your tribute can be a unique and personal reflection of you.PREFERRED FUNERAL HOME:NAME OF FUNERAL HOMESTREET ADDRESSCITY/COUNTYSTATEZIPPHONE EMAIL/WEB ADDRESSTYPE OF SERVICE: m Funeral m Cremation m Memorial m OtherPLACE OF SERVICE:m Funeral Home m Church/Chapel m Cemetery Chapel m Cemetery Graveside m Synagogue/Temple m OtherSERVICE PREFERENCE: m Religious m Non-religious m Celebrant/Clergy/SpeakerOTHERPERSONAL OR RELIGIOUS PREFERENCESWhat are some special reminders of you?KEEPSAKES FOR GUESTSSPECIAL THEME OR DÉCORSELECTED READINGS (poetry, religious passages or other special selections)MUSICIANSMUSICAL SELECTIONSA floral theme close to your heart.A keepsake is a unique token for gueststo take with them following a service.It can represent a cherished memory,special event or beloved hobby.Perhaps it’s an engraved golf ball,a seed packet or something that waspart of a personal collection.8Dignity Memorial From colorful blooms to elegant displays,flowers can say so much.FLORAL PREFERENCES
SERVICE PREFERENCESTYPE OF CASKET: m Hardwood m Metal m Cremation/Ceremonial Casket m All Wood Construction/m Selected and prepaid on/m Selected and have not paidTYPE OF URN: m Wood m Metal m Porcelain m OtherPARTICIPATING ORGANIZATIONS: (military, fraternal, lodge, etc.)ORGANIZATION NAME(S)OBITUARY: m Newspaper(s)m Onlinem OtherFLAG: m Draped m Folded m Presented toWAKE/ROSARY: m Yes m No m Locationm OfficiantVISITATION: m Yes m No m Public m Private Casket: m Open m Closed m OtherCLOTHING PREFERENCE: m From current wardrobe m NewCLOTHING DESCRIPTIONm Stays on m Returns to familyJEWELRY DESCRIPTIONm Stays on m Returns to familyEYEGLASSES DESCRIPTIONm Stays on m Returns to familyOTHER/DESCRIPTIONm Stays on m Returns to familyFavorite touches can makea service personal and meaningful.A special meal, the reading ofa treasured verse or music you’vealways enjoyed—make your servicea personal reflection of you.MEMORIAL DONATIONS TO:PALLBEARER INMENTADDITIONAL REQUESTSPersonal Planning Guide9
MEMORIALIZATION PREFERENCESPreserve your legacy and leave family and friendsa lasting place to reflect and remember.PREFERRED MEMORIAL PARK/CEMETERY:NAME OF MEMORIAL PARK/CEMETERYSTREET ADDRESSCITY/COUNTYSTATEZIPPHONE EMAIL/WEB ADDRESSTYPE OF ARRANGEMENTS: m Family Estate m Companion m Single m Otherm Selected and prepaid on//m Selected and have not paidChoose a special place of lastingremembrance where family and friendscan visit and reflect.TYPE OF INTERMENT RIGHTS:m Mausoleum m Niche m Lawn Crypt m Ground Burialm Cremation Garden m Other/m Selected and prepaid on/m Selected and have not paidNAME OF 0WNER OF INTERMENT RIGHTSLEGAL DESCRIPTION OF INTERMENT RIGHTSLOCATION OF CERTIFICATE OF OWNERSHIPOUTER BURIAL CONTAINER:m Concrete Vault m Metal Vault m Grave Linerm Otherm Selected and prepaid on//m Selected and have not paidTYPE OF CEMETERY SERVICE:Most of us don’t realizehow important remembrance isto those who love us.OPENING AND CLOSING (Quantity/Description)m Selected and prepaid onm Selected and have not paid10Dignity Memorial //
MEMORIALIZATION PREFERENCESMEMORIALIZATION:m Monument m Bronze Plaque on Granite Base m Bronze Plaque m Granite Plaque m OtherINSCRIPTION/EMBLEM/m Selected and prepaid on/m Selected and have not paidLeave a permanent tributethat celebrates special memoriesand family heritage.PERSONAL REQUESTS:Family present during closing upon conclusionof Committal Service: m Yes m NoFrom a serene outdoor setting to theelegance of an enclosed mausoleum,your final resting place can reflectyour special life and story.Release of:m Doves m Butterflies m Balloonsm OtherADDITIONAL REQUESTS:MILITARY HONORS:FLORAL PLACEMENT al Planning Guide11
TRANSPORTATION & RELOCATION PROTECTION PLAN * INFORMATIONThe Transportation & Relocation Protection Plan helps families cope with the unexpected.With just one phone call, you can take care of everything you need to bring a loved one home.TRANSPORTATION & RELOCATION PROTECTION PLAN: m Yes m NoCONTRACT NUMBER BENEFICIARYNAME OF RECEIVING FUNERAL HOMESTREET ADDRESSCITY/COUNTYSTATEZIPPHONE EMAIL/WEB ADDRESSORGANIZATIONS TO CONTACTUse this area to note any organizations or groups that may need to be notified upon your passing.NAME OF ORGANIZATIONCONTACT PERSONSTREET PHONE EMAIL/WEB ADDRESSNAME OF ORGANIZATIONCONTACT PERSONSTREET ADDRESSCITY/COUNTYPHONE EMAIL/WEB ADDRESSNAME OF ORGANIZATIONCONTACT PERSONSTREET ADDRESSCITY/COUNTYPHONE EMAIL/WEB ADDRESSNAME OF ORGANIZATIONCONTACT PERSONSTREET ADDRESSCITY/COUNTYPHONE EMAIL/WEB ADDRESS*Program services offered by Medical Air Services Association, Inc. and its affiliates. Not available in KY, NY and SC.12Dignity Memorial
PEOPLE TO CONTACTUse this area to note family, friends, coworkers and othersyou would like to be notified of your rsonal Planning Guide13
SOCIAL SECURITY INFORMATIONTo facilitate receiving Social Security benefits, you will need the following when you contact yourSocial Security office:1. Social Security Number2. Marriage License3. Children’s Birth Certificates4. W2 for the previous two years5. Proof of widow(er)’s age if 62 years or older6. Certified Copy of Death CertificateAn application for the lump sum death payment usuallymust be made within two years after the worker’s death.Don’t delay applying because you don’t have all theproof of information. The people in the Social Securityoffice will tell you about other proof of information thatcan be used when you apply.A lump sum payment may be made when an eligibleperson dies. This payment can only be made if there isan eligible surviving widow, widower or entitled child.Also, survivor’s checks may go to certain members ofa worker’s family.It is a good idea to check your record every three yearsto make sure that earnings are being correctly reportedto your record.SOCIAL SECURITY ADMINISTRATION1-800-772-1213 www.ssa.govMILITARY SERVICEBRANCH OF SERVICESERVICE SERIAL NUMBER//DATE ENTERED SERVICEPLACETYPE OF SEPARATION OR DISCHARGE OF SERVICEDATE//PLACE OF SEPARATIONLOCATION OF MILITARY DISCHARGE PAPERS (DD-214)HIGHEST GRADE, RANK OR RATING RECEIVEDWARS/CONFLICTS SERVEDADDITIONAL INFORMATION/MEDALS/HONORS/CITATIONSFor more information on Veteransbenefits, please request a FREEVeterans Planning Guide from yourDignity Memorial professional.14Dignity Memorial
ESTATE INFORMATIONImportance of a WillIf you die without a will, state law and the courts maydetermine who will administer your estate, handle financialmatters and act as guardian for your minor children.With a will, you decide.In some instances, joint ownership of property maynot be a good substitute for a carefully drafted will.For instance, if you and your spouse died as a resultof a common accident, before the survivor had anopportunity to execute a proper will, your propertywould pass to whom/what according to state law.You should review your will every few years, particularlyif you have moved or your family situation has changedsince you last executed a will. State laws vary as toformal requirements and as to the rights of children andgrandchildren born after a will was executed.When you realize how much is at stake — the well-beingof your entire family and the protection of your property —we believe that you will find that the attorney’s feefor drafting your will and planning your estate is aworthwhile investment.The law is very exacting in its requirements with respectto the publications, signing and witnessing of wills. It isrecommended that this matter be handled by a competentattorney. Homemade wills may not stand up in court.MY WILLI HAVE A WILL: m No m Yes – Date of Will (MM/DD/YYYY)//LOCATION OF WILL: m At home m Attorney’s office m OtherEXECUTOR/EXECUTRIX:NAMESTREET ADDRESSCITY/COUNTYSTATEZIPCITY/COUNTYSTATEZIPPHONE EMAIL ADDRESSPREPARED BY:NAMESTREET ADDRESSPHONE EMAIL ADDRESSSENIOR LIVING SOLUTIONSThrough a special partnership with Brookdale, the industry leader in Senior Living Solutions, Dignity Memorial customers enjoy access to a complete range of senior living communities with unparalleled services. Planning nowfor your later years in life is a gift that can bring you and your loved ones true peace of mind. Call 1-888-305-5647for a complimentary Brookdale Senior Living Guide and consultation.Personal Planning Guide15
FINANCIAL INFORMATIONBANKING:BANK NAME BRANCHType of account: m Checkingm Savingsm OtherUSERNAME PASSWORDBANK NAME BRANCHType of account: m Checkingm Savingsm OtherUSERNAME PASSWORDBANK NAME BRANCHType of account: m Checkingm Savingsm OtherUSERNAME PASSWORDCREDIT CARDS:m Visam MasterCardm American Expressm Discoverm OtherACCOUNT NUMBER EXPIRATION DATEUSERNAME PASSWORDm Visam MasterCardm American Expressm Discoverm OtherACCOUNT NUMBER EXPIRATION DATEUSERNAME PASSWORDm Visam MasterCardm American Expressm Discoverm OtherACCOUNT NUMBER EXPIRATION DATEUSERNAME PASSWORDm Visam MasterCardm American Expressm Discoverm OtherACCOUNT NUMBER EXPIRATION DATEUSERNAME PASSWORD16Dignity Memorial
FINANCIAL INFORMATIONLIFE INSURANCE/BENEFITS:LOCATION OF POLICYType: m Termm Whole Lifem Universalm Groupm OtherNAME OF COMPANY PHONEPOLICY NUMBER BENEFICIARY AMOUNTLOCATION OF POLICYType: m Termm Whole Lifem Universalm Groupm OtherNAME OF COMPANY PHONEPOLICY NUMBER BENEFICIARY AMOUNTREAL ESTATE HOLDINGS:DESCRIPTIONADDRESSDEED LOCATION DEED HOLDING INSTITUTIONDESCRIPTIONADDRESSDEED LOCATION DEED HOLDING INSTITUTIONFINANCIAL ASSETS:TYPE/DESCRIPTIONLOCATIONCOMPANY CONTACT PHONEPERSONAL BEQUESTSOTHER LOAN INFORMATION:Personal Planning Guide17
ONLINE PROFILESList your email, social media accounts orother important login information.ACCOUNT NAMEACCOUNT NAMEWEB ADDRESS/URLWEB ADDRESS/URLUSERNAMEUSERNAMEPASSWORDPASSWORDOTHER INFORMATIONOTHER INFORMATIONACCOUNT NAMEACCOUNT NAMEWEB ADDRESS/URLWEB ADDRESS/URLUSERNAMEUSERNAMEPASSWORDPASSWORDOTHER INFORMATIONOTHER INFORMATIONACCOUNT NAMEACCOUNT NAMEWEB ADDRESS/URLWEB ADDRESS/URLUSERNAMEUSERNAMEPASSWORDPASSWORDOTHER INFORMATIONOTHER INFORMATIONACCOUNT NAMEACCOUNT NAMEWEB ADDRESS/URLWEB ADDRESS/URLUSERNAMEUSERNAMEPASSWORDPASSWORDOTHER INFORMATIONOTHER INFORMATION18Dignity Memorial
THE DIGNITY DIFFERENCECelebrating each life like no other.Dignity Memorial professionals are committed to providing a superior customer experience.In addition to celebrating each life with highly personalized send-offs, there are many uniquebenefits and services that only your Dignity Memorial providers can offer.BEREAVEMENT TRAVEL ASSISTANCENATIONAL PLAN TRANSFERABILITYOur nationwide network allows us to partner withglobal experts who will assist you and your familywith time-sensitive travel arrangements. The benefitto you is clear: providing the best available options sothat you can be with those who mean so much whenit matters most.When you have a plan with a Dignity Memorialprovider and move more than 75 miles away, yourprearranged funeral services are fully transferableand will be honored by any of the more than 2,000Dignity Memorial providers in North America.CHILD & GRANDCHILD COVERAGEThe Dignity Memorial Personal Planning Guide is avaluable tool to help you organize vital end-of-lifeinformation. It takes you through the planning processstep by step and lets you record your final wishes,personal affairs, family heritage, military history,estate information and more into a single,centralized document.If you have a Dignity Memorial plan and sufferthe loss of a child or grandchild, we will providecomplimentary funeral or cremation servicesup to the same level as your plan through anyDignity Memorial provider nationwide.Subject to terms and conditions, including that the child or grandchildmust be under the age of 21 and unmarried. Not available in MD.THE COMPASSION HELPLINE The Compassion Helpline offers families unlimitedcomplimentary phone access to professional griefcounselors for 13 months after services are providedby any Dignity Memorial provider throughout NorthAmerica. In addition, anyone who attends a visitation,chapel or memorial service will have three monthsaccess to the Compassion Helpline.Services provided by Charles Nechtem Associates, Inc.DIGNITY MEMORIAL GUIDANCE SERIES Losing someone close to you and the accompanyinggrief can be hard to comprehend. Our GuidanceSeries, a grief management resource library, wasdeveloped to support and comfort anyone dealingwith these complex emotions.FAMILY PROTECTION PLANShould you pass away before your purchased cemeteryproperty is paid for, our Family Protection Plan ensuresthat any remaining balance due to the cemetery will bewaived and will not be your family’s responsibility.PERSONAL PLANNING GUIDETRANSPORTATION & RELOCATIONPROTECTION PLANThe unexpected death of a loved one can be startlingand emotionally difficult to navigate. When thatperson is far away, it can add an additional layer ofstress. When this option is selected, with just onephone call, our professionals will take care of all thenecessary details to bring your loved one home sothat you can focus on honoring their memory.Program services offered by Medical Air Services Association, Inc.and its affiliates. Not available in KY, NY and SC.100% DIGNITY SERVICE GUARANTEEThe Dignity Memorial network is the only family offuneral homes and cemeteries that measures thevoice of every customer through our customersatisfaction program, administered by J.D. Power andAssociates. We are fully committed to service beyondexpectation and if there is anything we can do tobetter serve you before, during or after the service, letus know and we will act on it immediately.Some restrictions may apply.Personal Planning Guide19
FINAL ARRANGEMENT COMPLETIONThis check sheet is designed to help you and your family have an understanding of which specificarrangements you have already made and what arrangements are yet to be taken care of.It is important to update this document each time add-on arrangements are completed. Your funeral/cemeteryprofessional will initial each part of the arrangement that you complete. If you choose to cancel payment for specificarrangements, those arrangements will cease to be in effect and will have to be arranged on a pre-need basis to beactive, or arranged at the time of need.GENERAL PRICE leumNicheLawn CryptGround BurialCremation GardenMusic/ReadingsAdditional//DATE SELECTEDDATE SELECTEDDATE SELECTED////TRANSPORTATION& RELOCATIONPROTECTION PLANMEMORIALIZATIONDATE SELECTEDDATE SELECTED///CASKET/URNCEMETERY/SERVICEFEESDATE SELECTEDDATE SELECTED//FUNERAL/MEMORIALSERVICEDATE SELECTED/20OUTER BURIALCONTAINERDignity Memorial ////
share your planwith those closest to you.It’s important to let those closest to you know that you’verecorded your final wishes and personal information.Keep your completed planner in a safe but familiar placeand let others know where it is located.
to myloved ones.It’s my wish that my final good-bye is a reflection of all I have been and loved.This planner includes personal information and details concerning my final arrangements.Please know that it was thoughtfully prepared with you in mind. I hope these pageswill relieve you of some unnecessary stress and guesswork at the time of my death.I also hope these pages serve as a lasting memory of my life.To my cherished family and dear friends, I leave these thoughts and my love.SIGNATURE22Dignity Memorial DATE
ASSISTING FAMILY AND FRIENDSIf you have friends or family members who you believe might find this planner helpful,please record their contact information here.NAME OF RELATIVE/FRIENDNAME OF RELATIVE/FRIENDPHONENUMBER OF IPRELATIONSHIPFRIENDFRIENDSUGGESTED BYSUGGESTED BYNAME OF RELATIVE/FRIENDNAME OF RELATIVE/FRIENDPHONENUMBER OF CHILDRENADDRESSCITYSTPHONEZIPNUMBER OF IENDFRIENDSUGGESTED BYSUGGESTED BYNAME OF RELATIVE/FRIENDNAME OF RELATIVE/FRIENDPHONENUMBER OF CHILDRENADDRESSCITYNUMBER OF CHILDRENSTPHONEZIPNUMBER OF IENDFRIENDSUGGESTED BYSUGGESTED BYSTZIPPersonal Planning Guide23
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This planning guide was designed to help you record and organize important information, personal thoughts and your final wishes. Making final plans now is one of the most thoughtful gifts you can give your family. And, when you plan ahead, your Dignity Memorial professionals can help you coordinate
