Personal Planning Guide - Romero Family Funeral Home And .

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Personal Planning GuideFor:My reasons forplanning ahead:

Vital informationGender (Check one) M FPERSONAL INFORMATIONFirst nameMiddleSocial Security numberDate of birthCurrent addressCityPhone numberLastBirthplace (City, County, State)StateDaytime phoneMarital status (Check one) Single MarriedZipEmail address Widowed DivorcedRace/nationalitySpouse’s full maiden nameMarriage datePlaceDate of deathDeceased (Check one) Y NFather’s nameDeceased (Check one) Y NMother’s maiden namePROFESSIONAL HISTORYLifetime occupationPosition held/Job titleIndustryEmployerNumber of years with employerRetired(Check one) Y NEDUCATIONEducation level completedHigh School attendedCityStateYear of graduationCollege attendedCityStateYear of graduationDegree(s) received1

Responsibility to those I loveMILITARY RECORDSVeteran (Check one) Y NBranch of MilitaryRankEnlistment dateDischarge dateService numberDischarge papers enclosed (Check one) Y NCOMMUNITY AFFILIATIONSLodges, memberships & public offices heldChurch (name, denomination, involvement)Awards & certificationsOBITUARY INFORMATIONLocal newspaper name (Funeral Home will notify)Other newspapers (include name of newspaper, city, state)Picture enclosed (Check one) Y N2

Family recordFAMILY INFORMATIONNameAddressPhoneSpouse/loved -GrandchildrenOthers3

Responsibility to those I lovePRECEDED IN DEATHNameRelationshipNameRelationshipLOCAL CONTACTS TO BE NOTIFIED AT THE TIME OF DEATHNameNameAddress AddressCityStateZipPhonePhoneIMPORTANT LEGAL INFORMATION FOR FAMILY USEInsurance (include company name, policy #, type and amount)Safe deposit box atAttorney’s nameExecutor of EstateAddressDo you have a will? (Check one) Y NPhoneLocation of WillAny additional pertinent information4

My Celebration of Life DetailsFUNERAL SERVICE SELECTIONSFuneral HomeLocation/CityService locationService typeOfficiant nameCemeteryLocation/CitySection lotProperty Purchased (Check one) Y NMarker purchased (Check one) Y NCasket/UrnOuter containerMemorial package selectionSPECIAL INSTRUCTIONSMusic selectionsNumberVocalist name and phoneOrganist name and phoneNumberVocalist name and phoneOrganist name and phoneSpecial �s ��s namePhoneFlower requestsPersonal instructionsClothingJewelryGlasses worn (Check one) Y NReligious items5OtherJewelry returned (Check one) Y NGlasses returned (Check one) Y N

Peace of Mind PARTICIPATING ORGANIZATIONS (FRATERNAL/MILITARY)PALL BEARER’S NAMESMEMORIAL CONTRIBUTION DESIGNATIONOrganization nameCity/StateOrganization nameCity/StateADDITIONAL INFORMATIONAuthorizationI,, have given the preceding informationto be filed in the funeral home of my choice, in order to avoid placing all responsibility onfamily and loved ones at the time of my death.Authorized byDate6

Compliments of:Forethought Life Insurance CompanyAdministrative officeOne Forethought CenterBatesville, IN 47006Phone: 1-800-331-8853Email: ask us@forethought.comwww.forethought.comM8299-07Peace of Mind is a registered trademark of Forethought Financial Services, Inc. 2012 Forethought0211

Forethought Life Insurance Company Administrative office One Forethought Center Batesville, IN 47006 Phone: 1-800-331-8853 Email: Title: M8299-07

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