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Complete and leave a copy with your will, with your attorney, your spouse, or your caretaker.
Updated____________
Name__________________ Address_____________________
SS #_______________ City___________________________
e-mail______________ State _ Zıp_______ Phone______________
Cell phone_____________________
Spouse________________________
SS #__________________________
e-mail_________________________
Cell phone_____________________
Attorney________________________
Phone______________ FAX_____________
Cell phone__________ e-mail
Accountant________________________
Phone______________ FAX_____________
Cell phone______________ e-mail______________________
Stockbroker_________________________
Phone______________ FAX_____________
Cell phone______________ e-mail______________________
Financial Planner_________________________
Phone______________ FAX______________
Cell phone______________ e-mail______________________
Passwords
Computer_____________ Internet Provider______________
DSL/Cable Connection___________ e-mail_______________
Other Passwords______________
In This Section Note Children, Grandchildren, People in your will
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
Executors & ~ııstees
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
Name________________________
Phone_____________ Cell Phone
FAX_____________
e-mail_______________________
From this point on, allow space within entries for whatever ıs applicable: phone, cell phone, fax, e-mail, account numbers, descriptions, company names, persons' names, key numbers, safe deposit numbers, expiration dates.
Medical
Physicians
Name_____________ Specialty Phone
Name_____________ Specialty Phone
Name_____________ Specialty Phone
Dentist Name_______________ Phone
Ueterinary
Name_____________________ Phone_____________
(give name, breed, color, bırth date, date annual shots due, habits-i.e. indoor or outdoor-for each pet)
Medical-Insurance
Medicare pending______________
Medicare (spouse) pending_______________
Long-Term Health Care
Policy Number______________ Company_____________
Agent______________ Phone number______________
Financial Banks
Name_____________________ Location
Checking Account #______________
Savings Account #______________
Financial Information
Name____________________ Location__________________
Checking Account #______________
Savings Account #______________
Mortgage Information
Name of holder_______________ Account #_______________
Amount paid monthly________
Address_____________
Phone number______________
Name of holder_______________ Account #
Amount paid monthly______________
Address_____________
Phone number______________
Brokerages
Name of Firm______________
Name of Broker______________
Account Number______________
Federal Taxes Due dates___________ Amounts
State Taxes Due dates_____________ Amounts_____________
Real Estate Taxes Property Address_______________
Due dates______________ Amounts______________
Real Estate Taxes Property Address_______________
Due dates______________ Amounts______________
Social Security
Amount Received___________ By Check________________
By Direct Deposit____________
Pension Name of Provider______________________________
Amount Received Due date
Life Insurance Policies
Name of Agent_____________
Phone Number_______________ Policy Number
Insurance Company______________
Amount of Policy______________
Name of Agent____________
Phone Number_____________ Policy Number___________
Insurance Company______________________
Amount of Policy_________
Auto Insurance Policies
Name of Agent____________
Phone Number_____________ Policy Number___________
Insurance Company______________________
Amount of Policy_________
Liability Insurance Policies
Name of Agent____________
Phone Number_____________ Policy Number___________
Insurance Company______________________
Amount of Policy_________
Home Insurance Policies
Name of Agent____________
Phone Number_____________ Policy Number___________
Insurance Company______________________
Amount of Policy_________
Other Insurance
Name of Agent____________
Phone Number_____________ Polıcy Number___________
Insurance Company______________________
Amount of Policy_________
Safe Deposit Box
Name of Bank____________
Location of Key & Other Information________________
Credit Cards
Name on card (primary card holder)
Card number______________
Identification secret word (like mother's maiden name, etc.)
________________________________________________
Household
Utilities
Electric Company phone number
Gas Company phone number Contractor that services heating/air conditioning
Name Phone number
Plumber Name Phone Landscaper/Gardener
Name of company Phone
Snow Removal Company Phone
Sanitation Company Phone
Home Telephone numbers &
Name of company Phone
Cell Phones &
Name of company Phone
Cable or satellite provider
Phone number
News Delivery Service Phone
E-Z pass number How is it paid for
Real estate agent Phone Automobiles
1 Dealership for service
Phone number
2 Dealership for service
Phone number
Emergency
Family (to call in emergency)
Name Phone
Name Phone
Name Phone
Neighbors (to call in emergency)
Name Phone
Name Phone
Name Phone
Housekeepers/aides/assistants
Name_____________________ Phone
Position___________________ SS#_____________
Name_____________________ Phone
Position__________________ SS#_____________
Alumni (who to contact)
Name_____________________ Phone
Affiliation (college, high school, etc)_______________
Location of documents and information
Insurance Policy Information
Kind of insurance (life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Location of policy
Kind of insurance (life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Location of policy
Kind of insurance (life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Location of policy
Kind of insurance (life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Location of policy
Kind of insurance
(life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Location of policy
Kind of insurance (life, auto, home owners, liability, etc.)
Name of company_____________ Name of agent___________
Phone_____________ Company______________
Address
Policy #_____________ Locatıon of polıcy
Financial Information
Location of wills & documents_______________
Location of deeds, surveys, moneys spent on improvements
Tax Information (current and prior years)
Location_____________
Stock Certificates
Location_____________
Automobile Title, Registration
Location_____________
Home/Condo Purchase information
Location_____________ |