Putting Your House in Order Putting Your House in Order

One of the most valuable gifts you can leave to your heirs is a well-organized estate and accurate records of your important personal data. The form that follows is intended to provide an organized structure for you to record important personal data. Your heirs will thank you for printing the following form and completing this information — do it now!

PERSONAL AND FINANCIAL RECORDS FOR:

Name(s)______Date completed______

PERSONAL HISTORY

◆ Your full legal name, including maiden name______

◆ Your address______

______

◆ Your telephone number(s) Home______Cell______Work______

◆ Your state of domicile and date of domicile______

◆ Your home of record______

◆ Your date of birth______

◆ Your place of birth______

◆ Your Social Security number______

◆ The country of your citizenship, if other than the United States______

◆ Your marital status  single  married  divorced  separated  widowed

◆ Your spouse’s full legal name (including maiden name)______

◆ Your spouse’s address (if different from your own)______

◆ Your spouse’s date of birth______

◆ Your spouse’s place of birth______

◆ Your spouse’s Social Security number______

◆ The country of your spouse’s citizenship, if other than the United States______

◆ Date of marriage______

If you are divorced, answer A–C

A) Your former spouse’s full legal name, including maiden name______

B) Your former spouse’s addresses______

C) Date of marriage to former spouse______

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◆ Your children’s full legal names (including maiden and married names)

1)______

2) ______

3) ______

4)______

5) ______

◆ Your children’s addresses and phone numbers

1) Address______Phone______

2) Address______Phone______

3) Address______Phone______

4) Address______Phone______

5) Address______Phone______

◆ Your children’s date of birth

1) ______4) ______

2)______5)______

3)______

◆ Your father’s full legal name______

◆ Your mother’s full legal name (including birth or maiden name)______

◆ Your grandchildren’s full legal names (including maiden and married names)

1)______4)______

2)______5)______

3)______6)______

Additional Personal Information or Comments

______

______

______

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MILITARY SERVICE

◆ Your branch of service______

◆ Your dates of service______

◆ Your rank______

◆ Your service number______

◆ Your date of discharge______

◆ Type of discharge______

◆ Your service-connected disabilities (______%)

◆ Your pension and retirement information is located______

EMPLOYMENT

◆ Your present employer(s) and address(es)

1) Name______

Address______

2) Name______

Address______

◆ Your present work telephone number(s) 1)______2)______

◆ Your date(s) of employment 1)______2)______

◆ Your position(s) 1)______2)______

◆ Your employment benefits (life insurance plans, 401(k), pension plans, profit-sharing plans). Include contact information for each.

1)______

______

______

______

2)______

______

______

______

Additional Information or Comments

______

______

______

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REAL ESTATE

◆ Address(es) of real estate currently owned

1) ______

______

2) ______

______

3)______

______

◆ How the real estate is owned (sole owner or jointly)?

1) ______2) ______3)______

◆ If property is owned jointly, names and addresses of other owners

1) Name______

Address______

2) Name______

Address______

3) Name______

Address______

◆ Real estate purchase price

1) ______2) ______3)______

◆ Date real estate purchased

1) ______2) ______3)______

◆ Current tax assessment value

1) ______2) ______3)______

◆ Mortgage or deed of trust held by

1) ______2) ______3)______

◆ Current loan amount

1) ______2) ______3)______

◆ Location of deeds, deeds of trust, title insurance, title abstracts

1) ______

2) ______

3)______

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◆ If real estate is leased, provide name, address, and phone number of lessee and location of lease

1) Name______Phone______

Address______

Location of lease______

2) Name______Phone______

Address______

Location of lease______

3) Name______Phone______

Address______

Location of lease______

Additional Information or Comments on Real Estate ______

______

FINANCIAL ACCOUNTS

◆ Name of bank or financial institution(s)

1) ______

2) ______

3)______

4)______

5) ______

◆ Name of owner of account (Provide all joint owners’ names and addresses)

1) Name______

Address______

2) Name______

Address______

3) Name______

Address______

4) Name______

Address______

5) Name______

Address______

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◆ Account number(s)

1) ______

2) ______

3)______

4)______

5) ______

◆ Type of account (checking, savings, certificate of deposit, money market, Individual Retirement Account)

1) ______

2) ______

3)______

4)______

5) ______

◆ Current balance

1) ______

2) ______

3)______

4)______

5) ______

STOCKS AND BONDS

◆ Investment broker name

Name______

Address______

Phone______

◆ Name of owner of accounts (Provide all joint owners’ names and addresses)

1) ______

______

2) ______

______

3)______

______

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◆ Type of asset (stock, bond, mutual fund)______

◆ Account number, certificate number or serial number______

◆ Purchase price______

◆ Current value______

◆ Maturity date, if applicable______

◆ Location of certificates or bonds______

Additional Information or Comments on Stocks and Bonds

______

______

PASSWORDS/USERNAMES

◆ Type of Account, Username (UN), Password (PW) (i.e. financial institution, credit card, social media, etc.)

1)______UN______PW______

2)______UN______PW______

3) ______UN______PW______

4) ______UN______PW______

5) ______UN______PW______

6) ______UN______PW______

7) ______UN______PW______

8) ______UN______PW______

9) ______UN______PW______

10) ______UN______PW______

TAX RETURNS

◆ Location of filed tax returns______

◆ Name, address, and phone number of individual or company who prepared tax returns

Name______

Address______

Phone______

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AUTOMOBILES

◆ Make, model, year 1)______2)______

◆ Location of title 1)______2)______

◆ Loan amount 1)______2)______

◆ Name of holder of loan and address

1)______

2)______

◆ Name of owner (Provide all joint owners’ names and addresses)

1)______

2)______

Additional Information on Automobiles ______

______

BUSINESS INTERESTS

◆ Name of of business

1)______

2)______

◆ Type of business (sole proprietorship, partnership, limited liability company, corporation)

1)______

2)______

◆ Type and amount of ownership (sole owner, shares, membership interest)

1)______

2)______

◆ Estimated value of business or share of ownership interest 1)______2)______

◆ Name, address, and phone number of business contacts (CPA, attorney, manager, president)

1) Name______

Address______

Phone______

2) Name______

Address______

Phone______

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Additional Information on Business Interests ______

______

TITLED ASSETS

◆ Description of asset (boats, RVs, trailers, etc.)______

◆ Location of asset______

◆ Location of title to asset______

◆ Purchase price of asset______

◆ Current value of asset______

◆ Name of owner (Provide all joint owners’ names and addresses)

______

______

______

SAFE DEPOSIT BOXES

◆ Location of safe deposit box ______

◆ Location of key______

◆ Names and addresses of individuals with signature access to box

1) Name______

Address______

2) Name______

Address______

TRUST(S)

◆ Location of any trust 1)______2)______

◆ Date of trust 1)______2)______

◆ Name, address, and phone number of attorney who prepared trust

1) Name______

Address______

Phone______

2) Name______

Address______

Phone______

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◆ Name, address, and phone number of trustee(s)

1) Name______

Address______

Phone______

2) Name______

Address______

Phone______

INSURANCE POLICIES

◆ Type of policy (life, health, disability, automobile, homeowners, renters)

1)______4) ______

2)______5) ______

3)______6) ______

◆ Policy number

1)______4)______

2)______5)______

3)______6)______

◆ Name, address, and phone number of insurance agent

1)______

2) ______

3)______

4)______

5)______

6)______

◆ Amount of coverage

1)______4) ______

2)______5) ______

3)______6) ______

◆ Location of insurance policy(ies)______

______

______

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FUNERAL/BURIAL INSTRUCTIONS

◆ Instructions for burial or cremation______

◆ Cemetery name and address and lot numbers, if applicable______

______

◆ Location of deed to cemetery lot, if applicable______

______

◆ Special wishes for ceremony ______

______

◆ Prepaid funeral policy is with______

WILL

◆ Date of Will and any codicils______

◆ Name, address, and phone number of attorney who prepared Will

Name______

Address______

Phone______

◆ Name, address, and phone number of executor/executrix

Name______

Address______

Phone______

◆ Location of original Will and any codicils______

FINANCIAL POWER OF ATTORNEY

◆ Name, address and phone number of attorney-in-fact (agent)

Name______

Address______

Phone______

◆ Location of original power of attorney______

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MEDICAL POWER OF ATTORNEY OR HEALTH CARE REPRESENTATIVE

◆ Agent name, address, and phone number

Name______

Address______

Phone______

◆ Location of power of attorney______

LIVING WILL

◆ Location of Living Will______

ADDITIONAL CONTACTS

◆ Attorney name, address, and phone number

Name______

Address______

Phone______

◆ Accountant name, address, and phone number

Name______

Address______

Phone______

◆ Doctor(s) name(s), address(es), and phone number(s)

1) Name______

Address______

Phone______

2) Name______

Address______

Phone______

3) Name______

Address______

Phone______

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IMPORTANT PERSONAL FRIENDS

The following individuals should be notified of my death

1) Name______Phone______

2) Name______Phone______

3) Name______Phone______

4) Name______Phone______

5) Name______Phone______

6) Name______Phone______

7) Name______Phone______

8) Name______Phone______

9) Name______Phone______

10) Name______Phone______

11) Name______Phone______

12) Name______Phone______

13) Name______Phone______

14) Name______Phone______

15) Name______Phone______

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