INFORMATION AND INSTRUCTIONS ON FINAL AFFAIRS

Name ________________________ Date ________

Address ________________________ Soc. Sec. No. ________________

I request that the Religious Society of Friends carry out the following upon my death:

The information below may help those responsible carry out my wishes:

1. Persons to notify at once: (next of kin, co-workers, executor, &c.)

CERTIFICATE OF TRANSFER

                           Date

To the ________________________ Monthly Meeting,

Address ________________________ Postal Code ________

Dear Friends,