Final Wishes Forms

We have been asked by several departments to come up with a template on "Final Wishes" that their department could use...

Purpose of form: The information in this form provides guidance to your Fire Chief regarding your wishes to be carried out upon your death.

Privacy Statement: This information may be protected by the current laws, rules, regulations, and policies regarding privacy and confidentiality as mandated by the your Fire Department and Rescue Squad, Inc., in your City of and the State of Nebraska or any other agency or branch of government.

Instructions for completing this Final Request Form: Before completing this form, read each statement carefully on the Memorandum which accompanies this form. After you have read the Memorandum, complete each item on this form. If the item does not apply or you prefer not to provide the Information, specify by writing ‘N/A’ to the item. Please print or type.
 

Final Wishes Form (Word doc)

Final Wishes Form (pdf)