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Memorial Service for A Miscarriage
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Planning Your Funeral This form records pertinent information and your current thinking and preferences regarding arrangements at the time of your death. It can be filed in the church office, with a copy made for a spouse, relative or friend. It can be updated at any time. If you want your funeral in Columbus, we encourage you to consider using the church building for the viewing, the funeral or memorial service, or any other arrangements you might prefer. The Pastors and Shepherding Team are available to discuss any of the information below. Third Way
Cafe also provides information on funeral planning on their site called
Address _________________________________________________________________ Phone ________________ Birthplace ______________ Date of Birth ________________ Spouse/Partner's Full Name ________________________ Date of Marriage ___________ Mother's Maiden Name _____________________________ Birthplace _______________ Address/Phone of Mother ______________________________________________________ Father's Name __________________________________Birthplace ____________________ Address/Phone of Father ______________________________________________________ Children and/or Siblings Relationship Address Phone
Each person is encouraged to prepare a life directive/living will and to discuss this with your family. If you would like help with completing this, please contact our pastors. I have prepared a life directive and/or living will yes _____ no _____ A copy of my life directive/living will is located:
Section 2 Funeral or Memorial Service Preferences Visitation:
I prefer: open casket _____ closed casket _____ no casket _____ I prefer:
I would like a fellowship meal at the church: yes _____ no _____ These scriptures are meaningful to me:
If possible, I would like the following individuals to serve as pallbearers:
Funeral Home Preference, if any Address/Phone of Funeral Home
Do you want an autopsy performed at the time of your death? Yes _____ No _____ Do you wish to be an organ donor? Yes _____ No _____ Do you wish your body to be embalmed? Yes _____ No _____ Do you wish your body to be cremated? Yes _____ No _____ If you prefer cremation, do you have any special wishes/instructions
regarding your ashes? Cemetery preference/location Plot #.
Occupation How long? Previous Jobs/Occupations Came to Central Ohio from? Lived here since (year) Other places you have lived? Service information (voluntary service, mission board, alternative service, etc.) Education (last grade completed, schools attended, etc.)
My Doctor (Name, address, phone)
Signature/Date
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