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Last Day Planner_NEW_PIC_2018

Telephone:______________________________________________________________ Name:________________________________________________________________ Relationship:____________________________________________________________ Address:________________________________________________________________ Telephone:______________________________________________________________ Name:_________________________________________________________________ Relationship:____________________________________________________________ Address:________________________________________________________________ Telephone:______________________________________________________________ Name:_______________________________________________________________ Relationship:___________________________________________________________ Address:________________________________________________________________ Telephone:______________________________________________________________ Name:_________________________________________________________________ Relationship:____________________________________________________________ Address:________________________________________________________________ 32

Additional Instructions and Information Additional instructions or information for survivors that has not been covered previously:____ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Date completed and/or updated:__________________________________________________ My Signature_________________________________________________________________ My Spouse’s Signature_________________________________________________________ Witness______________________________________________________________________ Address______________________________________________________________________ Witness______________________________________________________________________ Address______________________________________________________________________ CERTIFICATE OF ACKNOWLEDGEMENT OF NOTARY PUBLIC State of ____________, County of:_________________________________________ On _______________ before me, __________________________________________ (Name/Title, i.e., “Jane Doe, Notary Public”) personally appeared ______________________________________________________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. ______________________________ (Signature) (Notary Seal) 33

Live each day as the last day
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Last Day to Pre Register is May 20. Hotel Discount Ends May 20th.