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Fergerson Funeral Home, Inc.

215 South Main Street

North Syracuse, New York 13212

Phone (315) 458-1970

< Directors >

Alfred E. Fergerson Patricia H. Fergerson Alfred W. Fergerson

Print this page. Upon completion of this form, mail it to the above address. We will keep it on file.

Instructions For My Funeral

To Whom It May Concern:

In the pages that follow, I have recorded my desires and preferences regarding decisions you will be asked to make after my death. Please read through this entire document before making arrangements for my funeral.

_______________________________ _____________________________

Name Signature

_______________________________ _____________________________

Date Witness (optional)

Upon my death, I want to donate my organs as indicated:

____ Any needed organs or body parts

____ No Donation

____ Only those organs or body parts listed

_____________________________________________________

____I have a Living Will (location)

_____________________________________________________

Notification:

Please let all these people know of my death:

Spouse (Maiden Name) (& phone numbers)

_____________________________________________________

Children (& phone numbers)

_____________________________________________________

Parents (& phone numbers)

_____________________________________________________

Brothers and Sisters (& phone numbers)

_____________________________________________________

Friends (& phone numbers)

_____________________________________________________

Business Associates (& phone numbers)

_____________________________________________________

Place of Worship (& phone numbers)

_____________________________________________________

This is who I want to handle my funeral:

Funeral Director:

Alfred E. "Fred" or Patricia "Pat" Fergerson or Alfred W. "Bill" Fergerson

Funeral Home:

Fergerson Funeral Home, Inc.

Address:

215 South Main Street, North Syracuse, New York 13212

Phone: 315 458-1970

Details of my funeral:

Please ask these people to be my pallbearers :

_____________________________________________________

Speaker

_____________________________________________________

Location of Funeral

_____________________________________________________

Location of Burial

_____________________________________________________

I Prefer:

____ Flowers

____ Donations/Tributes to (charity or organization)

_____________________________________________________

Favorite Music

_____________________________________________________

Requested Readings

_____________________________________________________

Burial Wardrobe and Jewelry (Location)

_____________________________________________________

Preferred Style/Material for: (Circle preferences)

Casket:

Wood: Mahogany, Cherry, Birch, Oak, Maple, Pine, Hardwood, Cremation Container

Metal: Bronze, Copper, Steel, Stainless Steel Interior: Velvet, Crepe, Other

Burial Vault: Sealed Concrete w/ Liner, Sealed Concrete no Liner, Unsealed Box, Metal

Last Will and Testament:

Here is where you can find my will:

_____________________________________________________

Executor:

_____________________________________________________

Phone ______________________________

Other important papers:

This list will help you locate documents necessary for settlement of my estate (birth certificate, marriage license, divorce decree, military discharge, deeds, automobile titles, insurance policies, pension information, income tax records, banking records, bonds, securities, stock certificates, etc.).

Document/Location

_____________________________________________________

Location of Safety Deposit Key:

_____________________________________________________

Obituary: I've indicated here topics I would like included in my newspaper obituary:

Residence Listing: (Past and Present) (length at each )

_____________________________________________________

Spouse (maiden name)

_____________________________________________________

Date/Place of Marriage

_____________________________________________________

Children & Location

_____________________________________________________

Brothers and Sisters & Location

_____________________________________________________

Name & Address of Person designated to work with funeral director

_____________________________________________________

Birth Date & Location

_____________________________________________________

Education (schools & degrees)

_____________________________________________________

Military Service & Location of Discharge

_____________________________________________________

Occupation, Employers, Date of Retirement, Years Service

_____________________________________________________

Achievements/Awards

_____________________________________________________

Memberships, Activities, Offices Held:

_____________________________________________________

The funeral director will need this when filling out my death certificate:

Other Names I am known by: (AKA’s)

_____________________________________________________

Date & Place of Birth

_____________________________________________________

Marital Status (Married, Separated, Never Married, Divorced, Widowed)

_____________________________________________________

Social Security Number

_____________________________________________________

Usual Occupation (Do not enter "Retired")

_____________________________________________________

Kind of Business/Industry

_____________________________________________________

Last Company Worked for

_____________________________________________________

Military Service (dates, branch, medals)

_____________________________________________________

Highest Level of Education Completed & Schools attended

_____________________________________________________

Father's Name (first, middle, last)

_____________________________________________________

Mother's Name (first, middle, maiden, last)

_____________________________________________________

Place of Disposition (name and location of cemetery, crematory, or other place)

_____________________________________________________

Thank you for taking the time to fill-out this form. Please advise all who are close to you that your arrangements are on file at Fergerson’s. They should notify us of your death no matter where or when that occurs. If away from home, we will contact a local funeral home to arrange transportation home.

Fred, Pat & Bill Fergerson

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