Vital Information Chart
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Courtesy of  Bruns-Doric Vault Company, Inc.
 www.Bruns-Doric.com
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Today's Date 

Personal Information
Name: (first) 
(middle) 
(last) 
(maiden) 
Social Security Number
Street Address
City & State
Date of Birth
Birthplace
U.S. Armed Forces Serial Number 
Dates of service 
Rank or rating     
Commendations 
Educational Background (including names of schools graduation dates & degrees.)
1.
2.
3.
4.
Occupation
Employer
Employer Address
City & State
Date of Retirement

Father's Information
Name
Birthplace
Mother's Information
Maiden Name
Birthplace
Date of Marriage
If Widowed
Date of spouses death 
City of spouses death   
Previous Marriage
Date of termination 
Name of former spouse 

Location of Important Documents
Will
Living Will
Durable Power of Attorney for Health Care
Organ Donation Papers
Birth Certificate
Marriage License
Citizenship Papers
Legal Name Change Papers
(for adopted children) 
Deeds and Mortgage Papers
Pension Certificates
Automobile Titles
Bank Notes, Trust Papers
Stock & Bond Certificates
Income Tax Records
Check Book
Diplomas and Degrees
Inventory of HH Goods
Medical Records
Social Security Card
Unpaid Bills
Safety Deposit Box
Safety Deposit Box Key

Funeral Preferences
Funeral Director
Funeral Home
Address
Phone Number
Clergy Person
Address
Phone Number

Pallbearers: Name & Contact Information
1.
2.
3.
4.
5.
6.

Special Requests Regarding Music, Readings, Flowers
and Location of Funeral:
Casket - Type
Burial Vault - Type
Clothing - Type
Cemetery
Burial Plot
Location
Section Number
Block Number
Location of Deed

Notes/ Special Instructions: