Fillable My Burial Wishes Form printable pdf download

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U R I A L

I S H E S

In recognition of the fact that there may come a time, after my death, when decisions

To receive grave information please call:

will need to be made with regard to the care and disposition of my body, it is my

Name: ________________________________________________________________________________

desire and I, ____________________________________________________________________________________ ,

Address: ____________________________________________________________________

______________________________________________________________________________________________________

(Hebrew Name)

(Father’s Hebrew Name)

Tel. Day: _______________________________ Eve. _______________________________________

do hereby direct that

A. I object to any autopsy of my body except when permitted by Jewish law

Funeral Arrangements: The funeral home where I

B. My funeral should be conducted with the dignity and respect accorded by Jewish

❑ have already made pre-arrangements is:

law and tradition as described in the pamphlet entitled: “Dignity For The Body /

❑ would like to have my funeral arranged is:

Peace For The Soul.”

Designation of Rabbi or Alternate: Promptly, upon my death, in addition to

or in the absence of my family, please notify:

Name: ______________________________________________________________________

Rabbi: ________________________________________________________________________________

Phone: _____________________________ Ask for: _______________________________________

Address: ____________________________________________________________________

____________________________________________________________________________

Tel. Day: _______________________________ Eve. _______________________________________

Signature

Date

I request that any questions that may arise at the time of my death

(If you are not physically capable of signing, another person may sign your name

regarding dissection or autopsy of my body, donation of body organs,

on your behalf).

or the preparation for and the time of my burial, be made in consul-

tation with the Rabbi.

E C L A R A T I O N O F

I T N E S S

If the Rabbi listed is unavailable, please contact: Rabbi/Cong./Inst./Org./Chevra Kadisha

I declare that the person who signed (or asked another to sign) this document is per-

Name: ________________________________________________________________________________

sonally known to me and appears to be of sound mind and acting willingly and free

Address: ____________________________________________________________________

from duress. This document was signed in my presence.

Tel. Day: _______________________________ Eve. _______________________________________

Witness: ____________________________________________________________________

Location of Documents and Grave Information:

Residing at: _________________________________________________________________

My Last Will and Testament is located at:

____________________________________________________________________________

_____________________________________________________________________________________________________

____________________________________________________________________________

The deed or permit for my grave is located at:

_____________________________________________________________________________________________________

(It is recommended that copies of this form be given to the Rabbi

and the alternate designated therein, to the funeral director and

Name of cemetery: ___________________________________________________________

to your doctor, lawyer, family members, friends or social workers

Grave location: Sec. _______ Block no. _________ Row _______ Grave __________

who are likely to be contacted in the event of your death).

My Burial Wishes Form

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