Declaration of Intent
Benefits Information Services
Christian Ministry
There are No Application Fees or Costs
Confidential Information
- for my Loved Ones -
In order to register please COPY, PASTE ON MICROSOFT WORD, PRINT TO HARD COPY, COMPLETE IN PERSONAL HANDWRITING........
Pages 1, 2 and 3 below.....
Mail Copies To:
* Your Designated Person in Charge of Final Arrangements
* Your Designated Pastor and Church of Final Arrangements
* Your Other Family Members and Friends of Choice
Page 1
Page 2
* Designated Person in charge of * Designated Pastor, Church, Etc.
Final Arrangements. In charge of Final Arrangements.
Name________________________ Pastor__________________________
Relationship__________________ Church ____________________
Street________________________ Street__________________________
City_________State_____Zip____ City_________State______Zip_____
Phone_______________________ Phone_________________________
Closest Family and Friends
Name_______________________ Name_________________________
Relationship_________________ Relationship___________________
Street_______________________ Street_________________________
City_________State_____Zip___ City_________State_____Zip_____
Phone_______________________ Phone_________________________
Name_______________________ Name_________________________
Relationship_________________ Relationship___________________
Street_______________________ Street________________________
City_________State_____Zip___ City_________State______Zip____
Phone______________________ Phone_________________________
Notes:___________________________ Notes:_________________________
___________________________ _________________________
___________________________ _________________________
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Christian Ministry Outreach