In this booklet, you will find recorded information on decisions that I have made in advance to help you during this time.
If you will give this booklet to my funeral director, everything can be conducted in accordance with my written wishes. I believe that this effort will minimize the emotional strain that you are in at this time.
In this booklet, you will find vital statistics, estate information, funeral or cremation arrangements and other important information. I hope this, in someway, relieves you from the anxiety and burden of making these decisions at a very difficult time.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, and sample consent to treat form.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, sample consent to treat form, sample accommodation request for healthcare appointments.
Are you looking for a resource to assist with your ACA Enrollments? Need a method of storing client information without a CRM? Or perhaps, you are looking for a guide during the renewal consultant and need a better idea if your client should add additional benefits to their current health insurance plan? Agent Pipeline's Client Eligibility Toolkit is perfect for helping agents help their clients.
Box 13-7 Family Assessment GuideI Identifying DataName ______.docxbartholomeocoombs
Box 13-7 Family Assessment Guide
I Identifying Data
Name: ___________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
Phone number(s):_____________________________________________________________________________________________
Household members (relationship, gender, age, occupation, education):____________________________________________________
Financial data (sources of income, financial assistance, medical care; expenditures):___________________________________________
Ethnicity: __________________________________________________________________________________________________
Religion: __________________________________________________________________________________________________
Identified client(s):______________________________________________________________________________________________
Source of referral and reason: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
II Genogram
Include household members, extended family, and significant others
Age or date of birth, occupation, geographical location, illnesses, health problems, major events
Triangles and characteristics of relationships
III Individual Health Needs (for each household family member)
Identified health problems or concerns: ________________________________________________________________________________
Medical diagnoses: _____________________________________________________________________________________________
Recent surgery or hospitalizations: _________________________________________________________________________________
Medications and immunizations: _________________________________________________________________________________
Physical assessment data: ______________________________________________________________________________________
Emotional and cognitive functioning: _______________________________________________________________________________
Coping: _____________________________________________________________________________________________________
Sources of medical and dental care: ____________________________________________________________________________
Health screening practices: ____________________________________________________________________________________
IV Interpersonal Needs
Identified subsystems and dyads:________________________________________________________________________________
Prenatal care needed: _________________________________________________________________________________________
Parent–child interactions:__.
What are the main advantages of using HR recruiter services.pdfHumanResourceDimensi1
HR recruiter services offer top talents to companies according to their specific needs. They handle all recruitment tasks from job posting to onboarding and help companies concentrate on their business growth. With their expertise and years of experience, they streamline the hiring process and save time and resources for the company.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, and sample consent to treat form.
Sample Worksheets and Images Related to Healthcare Appointments Packet.pdfLarissa607805
Sample worksheets from various websites like Autism and Health, Healthcare Information Guide, and HealthyTransitionsNY.org.
Includes: Sample filled out making appointments worksheet, sample filled out appointment scheduler, sample filled out visit planner, sample image of calendar and insurance/benefit card, blank calendar and insurance/benefit card for practice, insurance/benefit card sample, POLDCARTS reference (what to write down or think about before a visit for a specific problem), sample HIPAA form, sample, sample consent to treat form, sample accommodation request for healthcare appointments.
Are you looking for a resource to assist with your ACA Enrollments? Need a method of storing client information without a CRM? Or perhaps, you are looking for a guide during the renewal consultant and need a better idea if your client should add additional benefits to their current health insurance plan? Agent Pipeline's Client Eligibility Toolkit is perfect for helping agents help their clients.
Box 13-7 Family Assessment GuideI Identifying DataName ______.docxbartholomeocoombs
Box 13-7 Family Assessment Guide
I Identifying Data
Name: ___________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
Phone number(s):_____________________________________________________________________________________________
Household members (relationship, gender, age, occupation, education):____________________________________________________
Financial data (sources of income, financial assistance, medical care; expenditures):___________________________________________
Ethnicity: __________________________________________________________________________________________________
Religion: __________________________________________________________________________________________________
Identified client(s):______________________________________________________________________________________________
Source of referral and reason: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
II Genogram
Include household members, extended family, and significant others
Age or date of birth, occupation, geographical location, illnesses, health problems, major events
Triangles and characteristics of relationships
III Individual Health Needs (for each household family member)
Identified health problems or concerns: ________________________________________________________________________________
Medical diagnoses: _____________________________________________________________________________________________
Recent surgery or hospitalizations: _________________________________________________________________________________
Medications and immunizations: _________________________________________________________________________________
Physical assessment data: ______________________________________________________________________________________
Emotional and cognitive functioning: _______________________________________________________________________________
Coping: _____________________________________________________________________________________________________
Sources of medical and dental care: ____________________________________________________________________________
Health screening practices: ____________________________________________________________________________________
IV Interpersonal Needs
Identified subsystems and dyads:________________________________________________________________________________
Prenatal care needed: _________________________________________________________________________________________
Parent–child interactions:__.
What are the main advantages of using HR recruiter services.pdfHumanResourceDimensi1
HR recruiter services offer top talents to companies according to their specific needs. They handle all recruitment tasks from job posting to onboarding and help companies concentrate on their business growth. With their expertise and years of experience, they streamline the hiring process and save time and resources for the company.
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Kyiv PMDay 2024 Summer
Website – www.pmday.org
Youtube – https://www.youtube.com/startuplviv
FB – https://www.facebook.com/pmdayconference
RMD24 | Debunking the non-endemic revenue myth Marvin Vacquier Droop | First ...BBPMedia1
Marvin neemt je in deze presentatie mee in de voordelen van non-endemic advertising op retail media netwerken. Hij brengt ook de uitdagingen in beeld die de markt op dit moment heeft op het gebied van retail media voor niet-leveranciers.
Retail media wordt gezien als het nieuwe advertising-medium en ook mediabureaus richten massaal retail media-afdelingen op. Merken die niet in de betreffende winkel liggen staan ook nog niet in de rij om op de retail media netwerken te adverteren. Marvin belicht de uitdagingen die er zijn om echt aansluiting te vinden op die markt van non-endemic advertising.
Enterprise Excellence is Inclusive Excellence.pdfKaiNexus
Enterprise excellence and inclusive excellence are closely linked, and real-world challenges have shown that both are essential to the success of any organization. To achieve enterprise excellence, organizations must focus on improving their operations and processes while creating an inclusive environment that engages everyone. In this interactive session, the facilitator will highlight commonly established business practices and how they limit our ability to engage everyone every day. More importantly, though, participants will likely gain increased awareness of what we can do differently to maximize enterprise excellence through deliberate inclusion.
What is Enterprise Excellence?
Enterprise Excellence is a holistic approach that's aimed at achieving world-class performance across all aspects of the organization.
What might I learn?
A way to engage all in creating Inclusive Excellence. Lessons from the US military and their parallels to the story of Harry Potter. How belt systems and CI teams can destroy inclusive practices. How leadership language invites people to the party. There are three things leaders can do to engage everyone every day: maximizing psychological safety to create environments where folks learn, contribute, and challenge the status quo.
Who might benefit? Anyone and everyone leading folks from the shop floor to top floor.
Dr. William Harvey is a seasoned Operations Leader with extensive experience in chemical processing, manufacturing, and operations management. At Michelman, he currently oversees multiple sites, leading teams in strategic planning and coaching/practicing continuous improvement. William is set to start his eighth year of teaching at the University of Cincinnati where he teaches marketing, finance, and management. William holds various certifications in change management, quality, leadership, operational excellence, team building, and DiSC, among others.
What is the TDS Return Filing Due Date for FY 2024-25.pdfseoforlegalpillers
It is crucial for the taxpayers to understand about the TDS Return Filing Due Date, so that they can fulfill your TDS obligations efficiently. Taxpayers can avoid penalties by sticking to the deadlines and by accurate filing of TDS. Timely filing of TDS will make sure about the availability of tax credits. You can also seek the professional guidance of experts like Legal Pillers for timely filing of the TDS Return.
RMD24 | Retail media: hoe zet je dit in als je geen AH of Unilever bent? Heid...BBPMedia1
Grote partijen zijn al een tijdje onderweg met retail media. Ondertussen worden in dit domein ook de kansen zichtbaar voor andere spelers in de markt. Maar met die kansen ontstaan ook vragen: Zelf retail media worden of erop adverteren? In welke fase van de funnel past het en hoe integreer je het in een mediaplan? Wat is nu precies het verschil met marketplaces en Programmatic ads? In dit half uur beslechten we de dilemma's en krijg je antwoorden op wanneer het voor jou tijd is om de volgende stap te zetten.
Discover the innovative and creative projects that highlight my journey throu...dylandmeas
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Improving profitability for small businessBen Wann
In this comprehensive presentation, we will explore strategies and practical tips for enhancing profitability in small businesses. Tailored to meet the unique challenges faced by small enterprises, this session covers various aspects that directly impact the bottom line. Attendees will learn how to optimize operational efficiency, manage expenses, and increase revenue through innovative marketing and customer engagement techniques.
Digital Transformation and IT Strategy Toolkit and TemplatesAurelien Domont, MBA
This Digital Transformation and IT Strategy Toolkit was created by ex-McKinsey, Deloitte and BCG Management Consultants, after more than 5,000 hours of work. It is considered the world's best & most comprehensive Digital Transformation and IT Strategy Toolkit. It includes all the Frameworks, Best Practices & Templates required to successfully undertake the Digital Transformation of your organization and define a robust IT Strategy.
Editable Toolkit to help you reuse our content: 700 Powerpoint slides | 35 Excel sheets | 84 minutes of Video training
This PowerPoint presentation is only a small preview of our Toolkits. For more details, visit www.domontconsulting.com
Attending a job Interview for B1 and B2 Englsih learnersErika906060
It is a sample of an interview for a business english class for pre-intermediate and intermediate english students with emphasis on the speking ability.
"𝑩𝑬𝑮𝑼𝑵 𝑾𝑰𝑻𝑯 𝑻𝑱 𝑰𝑺 𝑯𝑨𝑳𝑭 𝑫𝑶𝑵𝑬"
𝐓𝐉 𝐂𝐨𝐦𝐬 (𝐓𝐉 𝐂𝐨𝐦𝐦𝐮𝐧𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬) is a professional event agency that includes experts in the event-organizing market in Vietnam, Korea, and ASEAN countries. We provide unlimited types of events from Music concerts, Fan meetings, and Culture festivals to Corporate events, Internal company events, Golf tournaments, MICE events, and Exhibitions.
𝐓𝐉 𝐂𝐨𝐦𝐬 provides unlimited package services including such as Event organizing, Event planning, Event production, Manpower, PR marketing, Design 2D/3D, VIP protocols, Interpreter agency, etc.
Sports events - Golf competitions/billiards competitions/company sports events: dynamic and challenging
⭐ 𝐅𝐞𝐚𝐭𝐮𝐫𝐞𝐝 𝐩𝐫𝐨𝐣𝐞𝐜𝐭𝐬:
➢ 2024 BAEKHYUN [Lonsdaleite] IN HO CHI MINH
➢ SUPER JUNIOR-L.S.S. THE SHOW : Th3ee Guys in HO CHI MINH
➢FreenBecky 1st Fan Meeting in Vietnam
➢CHILDREN ART EXHIBITION 2024: BEYOND BARRIERS
➢ WOW K-Music Festival 2023
➢ Winner [CROSS] Tour in HCM
➢ Super Show 9 in HCM with Super Junior
➢ HCMC - Gyeongsangbuk-do Culture and Tourism Festival
➢ Korean Vietnam Partnership - Fair with LG
➢ Korean President visits Samsung Electronics R&D Center
➢ Vietnam Food Expo with Lotte Wellfood
"𝐄𝐯𝐞𝐫𝐲 𝐞𝐯𝐞𝐧𝐭 𝐢𝐬 𝐚 𝐬𝐭𝐨𝐫𝐲, 𝐚 𝐬𝐩𝐞𝐜𝐢𝐚𝐥 𝐣𝐨𝐮𝐫𝐧𝐞𝐲. 𝐖𝐞 𝐚𝐥𝐰𝐚𝐲𝐬 𝐛𝐞𝐥𝐢𝐞𝐯𝐞 𝐭𝐡𝐚𝐭 𝐬𝐡𝐨𝐫𝐭𝐥𝐲 𝐲𝐨𝐮 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐚 𝐩𝐚𝐫𝐭 𝐨𝐟 𝐨𝐮𝐫 𝐬𝐭𝐨𝐫𝐢𝐞𝐬."
1.
To My Loved Ones
In
this
booklet,
you
will
find
recorded
information
on
decisions
that
I
have
made
in
advance
to
help
you
during
this
time.
If
you
will
give
this
booklet
to
my
funeral
director,
everything
can
be
conducted
in
accordance
with
my
written
wishes.
I
believe
that
this
effort
will
minimize
the
emotional
strain
that
you
are
in
at
this
time.
In
this
booklet,
you
will
find
vital
statistics,
estate
information,
funeral
or
cremation
arrangements
and
other
important
information.
I
hope
this,
in
someway,
relieves
you
from
the
anxiety
and
burden
of
making
these
decisions
at
a
very
difficult
time.
Sincerely,
By:
____________________________________________
Date:
__________________________________________
Personal Information
Full
Name:
____________________________________________________________________________________
Sex:
_______________
Social
Security
Number:
____________________________________________
Date
of
Birth:
____________________________________
Birthplace:
City:
________________________________
State:
________
Race:
_______________
Usual
Occupation:
___________________________________________________________________________
Kind
of
Business/Industry:
_________________________________________________________________
Physical
Address:
____________________________________________________________________________
City:
_____________________________________
State:
_________
Country:
_________________
Inside
City
Limits:
Yes
_____
No
_____
Marital
Status:
_______________________________________________________________________________
2.
Surviving
Spouse
Name
(If
wife,
give
maiden
name):
__________________________________________________
Highest
grade
of
education
completed
(including
college):
________________________________________
Father’s
Name:
______________________________________________________________________________
Mother’s
Name
(Include
maiden
name):
_______________________________________________________
If
burial,
name
of
cemetery:
________________________________________________________________
Location:
_____________________________________________________________________________________
Contact
Person
Completing
Arrangements:
_______________________________________________
Their
Address:
_______________________________________________________________________________
Their
Phone
#:
_______________________________________________________________________________
Medical Information
Medical
information
can
have
many
important
uses
for
your
spouse,
children
and
grandchildren.
Physicians
often
ask
for
medical
information
from
family
members.
Medical
Insurance
Company
Name:
_______________________________________________________
1. Identification
#:
_____________________________________________________________________
2.
Group
#:
_____________________
Phone
#:
_____________________________________
3. Member
Name:
______________________________________________________________________
My
Physician:
__________________________________
Phone
#:
_____________________________
Address:
______________________________________________________________________________________
Medical
History
(Please
list
any
serious
or
chronic
medical
problems):
_______________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Medications
I’m
allergic
to:
_________________________________________________________________
3.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Living
Will:
Yes
_____
No
_____
Location:
_____________________________________________________________________________________
Remarks:
_____________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
I
am
an
Organ
Donor:
Yes
_____
No
_____
Remarks:
_____________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Obituary Information
If
you
wish
to
run
an
obituary,
you
may
use
the
following
form
with
information
to
assist
the
funeral
home
with
the
obituary.
Name:
_________________________________________________________________________________________
Length
of
time
living
in
your
present
city/state:
__________________________________________
Previously
from:
_____________________________________________________________________________
Religion:
______________________________________________________________________________________
Church:
_______________________________________________________________________________________
Preceded
in
death
by
the
following
relatives:
_____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Surviving
Relatives:
_________________________________________________________________________
4.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Use
the
form
below
to
list
any
achievements
and
accomplishments
you
are
proud
of.
Childhood:
___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Early
Adulthood:
____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Family
Moments:
____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Career:
________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Civic
Involvements:
_________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other
Achievements:
________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5.
Funeral Home Information
Funeral
Home/Crematorium:
______________________________________________________________
Place
of
Service:
_____________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Religious
Affiliation:
________________________
Location:
__________________________________
Clergyman/Speaker:
________________________________________________________________________
Other
Participants
(fraternal,
military,
etc…):
__________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Wake/Rosary
Service:
Yes
_____
No
_____
Officiator:
________________________________
Visitation/Viewing:
Yes
_____
No
_____
Flag
Presented
To
(if
applicable):
_____________________________________________________________
Clothing
Choice:
_____________________________________________________________________________
Personal
Items:
Jewelry
_______________
Remains
On
_____
Give
to:
______________________________________
Eyeglasses
________________
Remains
On
_____
Give
to:
_________________________________
Other
_______________
Remains
On
_____
Give
to:
________________________________________
Floral
Choice:
________________________________________________________________________________
Donations
may
be
made
to:
_________________________________________________________________
Music
Preferred:
_____________________________________________________________________________
Eulogy
By:
________________________________________________
Eulogy
Notes:
________________
6.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Open
Casket:
Yes
_____
No
_____
Type
of
casket
selected:
___________________________________________
$
_____________________
Color:
____________________________________
Interior
Color:
_________________________________
Type
of
urn
selected
if
cremation:
_________________________________________________________
Location
of
Pre-‐Need
Contract:
_____________________________________________________________
Suggested
Pallbearers
with
Phone
#’s:
____________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Honorary
Pallbearers
with
Phone
#’s:
_____________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Additional
Remarks/Special
Instructions,
etc.:
___________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Cemetery Information
Cemetery:
____________________________________________________________________________________
Address:
____________________________________________________
Phone
#:
____________________
Type
of
Plot:
Family
_____
Companion
______
Individual
_____
Type
of
Property:
Mausoleum
_____
Ground
Burial
_____
Cremation
Gardens
_____
Description:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7.
Location
of
Deed:
____________________________________________________________________________
Type
of
Vault:
________________________________________________________________________________
Type
of
Memorial:
Upright
Monument
_____
Bronze
Plaque
_____
Granite
Plaque
_____
Other:
_________________________________________________________________________________________
Inscription:
___________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Other
Images,
Emblems,
etc.:
_______________________________________________________________
If
Cremation,
what
type
of
final
arrangements?
___________________________________________
Burial
______
Niche
_____
Scattering
Garden
_____
Cremation
Garden
_____
Other:
_________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Plaque
Inscription:
__________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Additional
Remarks/Special
Instructions,
etc.:
___________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
People to Notify
Name
Relationship
Phone
#
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Organizations to Notify
Name
of
Organization
Contact
Person
Phone
#
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Social Security
The
loss
of
the
family
wage
earner
can
be
devastating
to
the
survivors.
The
social
security
office
offers
a
variety
of
booklets
concerning
survivor
benefits.
Of
course,
the
information
provided
does
not
contain
all
provisions
of
the
law.
Each
case
may
be
different
and
you
would
need
to
contact
Social
Security
pertaining
to
your
individual
needs.
You
can
speak
to
a
service
representative
between
7a.m.
and
7p.m.
on
business
days.
Remember
to
have
your
social
security
number
ready.
Internet
Website:
www.socialsecurity.gov
Toll
Free
Number:
1-‐800-‐772-‐1213
TTY
Number:
1-‐800-‐325-‐0778
When
someone
who
has
worked
and
paid
into
Social
Security
dies,
survivor
benefits
can
be
paid
to
certain
family
members.
These
include
widows,
widowers
(and
divorced
widows
and
widowers),
children,
and
dependent
parents.
9.
There
is
a
special
one-‐time
payment
that
can
be
made
when
you
die
if
you
have
enough
work
“credits.”
This
payment
can
be
made
only
to
your
spouse
or
minor
children
if
they
meet
certain
requirements.
When
a
death
occurs
you
will
need
the
following
information
for
Social
Security
if
you
are
not
already
receiving
benefits
from
Social
Security:
• Proof
of
death-‐either
from
funeral
home
or
death
certificate
• Your
Social
Security
number,
as
well
as
the
deceased’s
social
security
number
• You
birth
certificate
• Your
marriage
certificate
if
you’re
a
widow
or
widower
• Your
divorce
papers
if
you’re
applying
as
a
surviving
divorced
spouse
• Dependent
children’s
Social
Security
numbers,
if
available
• Deceased
worker’s
W-‐2
forms
or
federal
self
employment
tax
return
for
the
most
recent
year
• The
name
of
your
bank
and
your
account
number
so
your
benefits
can
be
directly
deposited
into
your
account
If
you
need
a
phone
number
to
your
local
Social
Security
office,
feel
free
to
call
the
funeral
director
you
worked
with
at
the
funeral
home.
He
or
she
should
be
able
to
provide
you
with
the
phone
number.
Armed Forces Information
For
benefits
information
and
claims
assistance
call
1-‐800-‐827-‐1000.
For
government
life
insurance
information
and
claims
assistance
call
1-‐800-‐699-‐8477.
The
National
Cemetery
will
verify
elgibility
of
all
applicants
and
will
maintain
the
schedule
for
the
Committal
Services
at
the
cemetery.
Most
Veterans
who
have
conditions,
are
entitled
to
burial
in
a
National
Cemetery.
Veterans
and
family
members
of
deceased
Veterans
can
request
copies
of
proof
of
veteran
military
service
(DD214)
forms
online
at:
www.archives.gov/research/index.html
You
can
also
use:
www.va.gov
Branch
Served:
___________________________________
Serial
Number:
_______________________
Date
Entered:
___________________________
Place:
__________________________________________
Highest
Grade,
Rank
Received:
_____________________________________________________________
Type
of
Discharge:
_______________________________________________
Date:
__________________
Place
of
Discharge:
__________________________________________________________________________
Location
of
Discharge
Papers
(DD214):
___________________________________________________
10.
Total
Active
Service:
Years
_____
Months
_____
Days
______
Served
in
Wars/Conflicts:
___________________________________________________________________
Citations/Honors/Medals
Received:
_______________________________________________________
Will & Important Documents
Will:
Yes
_____
No
______
Date
of
Will:
__________________________________________________
Will
Location:
________________________________________________________________________________
Executor/Executrix:
_________________________________________________________________________
Name:
_________________________________________________________________________________________
Address:
______________________________________________________________________________________
City:
___________________________________________
State:
______________
Zip:
________________
Prepared
By:
_________________________________________
Phone
#:
__________________________
Address:
______________________________________________________________________________________
City:
____________________________________________
State:
_____________
Zip:
________________
Other
Important
Documents:
_______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Financial Information
BANKING
Bank:
____________________________________________
Location:
_______________________________
Checking
Account:
_____________________________
Savings
Account:
_______________________
Other:
_________________________________________________________________________________________