DIARY OF PERSONAL WISHES
An easy first step you can take is to complete the Diary of Personal Wishes. This document will provide your family
with vital information required at a time when they will be under great stress.
Name______________________________________________________________________________________
Social Security Number________________________________________________________________________
Address____________________________________________________________________________________
City_________________________________________________
State_____________________________________________
Date of Birth___________________________________
Birthplace________________________________________________
U.S. Armed Forces Serial Number_________________________________________________________________
Occupation___________________________________________________________________________________
Name of Father_______________________________________________________________________________
Birthplace-City______________________________State____________________Country_____________________
Name of Mother (Maiden)________________________________________________________________________
Birthplace-City______________________________State____________________Country_____________________
RELATIVES AND FRIENDS TO BE CONTACTED:
Name____________________________________________ Phone( )________________________________
Name____________________________________________ Phone(
)_________________________________Name____________________________________________ Phone(
)________________________________
Name____________________________________________ Phone( )________________________________
Name____________________________________________ Phone( )________________________________
Name____________________________________________ Phone( )________________________________
FUNERAL PREFERENCES:
Funeral
Home________________________________________________________________________________________
Clergy_______________________________________________________________________________________
Where Funeral Is to Be
Held_______________________________________________________________________________
What Type of
Funeral_____________________________________________________________________________________
Casket Bearers________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________________
Special Requests_______________________________________________________________________________
Music, Readings, Flowers, etc._____________________________________________________________________
Type of Casket_________________________________________________________________________________
Clothing, Jewelry, etc.____________________________________________________________________________
Type of Burial Vault_____________________________________________________________________________
Cemetery_____________________________________________________________________________________
Family Burial Plot: Location_______________________________________________________________________
Number of Graves__________________________ Which Space_________________________________________
Other Spaces in Plot Reserved for:_________________________________________________________________
If There Is No Burial Plot Arranged, Where Is Burial
Preferred?____________________________________________________________________________________