Ministry in Time of Need

Concord Friends Meeting

(For clerks use)

Date Received _______________

Updated ____________________

Updated ____________________

Name ______________________________________________________

Address ____________________________________________________

Address ____________________________________________________ Phone _________________

□   I have prepared a Living Will/Durable Power of Attorney.

□   I have authorized donation of my body organs.

Location of these documents ________________________________________________________

In case of emergency or death, contact:

Name _____________________________ Relationship ______________ Phone _________________

Name _____________________________ Relationship ______________ Phone _________________

FINAL INSTRUCTIONS

1. I wish my remains to be disposed in the following way:
   
   □   Burial          □ Given for medical research with later: □ burial  □ green/natural burial  □ cremation
   
   □   Cremation   □ Ashes kept     □ Ashes not kept
2. My cemetery/burial preference is: (check all appropriate boxes)
   
   □ Friends Burial Ground      □ Regular grave site    □ Cremation site
   
   □ Single Marker                   □ Double Marker         □ No Marker
   
   □ Other Family Plot - Location ______________________________________________________
3. I wish to have a Quaker Memorial Meeting for Worship
   
   □ At Concord Friends Meeting
   
   □ Elsewhere - Location ____________________________________________________________
4. Memorial contributions in lieu of flowers can be given to ______________________________
5. Special concerns: Pets, Children, Aging Parents, Ailing Spouse, etc.
   
   How can the Meeting be of assistance?
6. Location of important papers ________________________________________________________
7. If donations are received in your memory by Concord Friends Meeting, do you wish to stipulate a special purpose, or may such contributions be added to general funds?

Feel free to attach other pertinent information such as biographical data for obituary notices; selected verses and readings for Memorial services, persons to notify; preferred style of headstone or inscription etc.

PLEASE REMAIN IN GOOD HEALTH FOR A LONG TIME YET