Name:
_______________________________ Date:
____________________
This form should be updated periodically and shared
with friends or family members who
would need access to these items if you died or
became disabled.
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Names |
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Relationship |
Name |
Telephone |
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Doctor |
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Attorney |
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Power of attorney |
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Designated guardian for minor children |
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Financial contact |
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Others who have this form |
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Documents |
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Type |
Where is it stored? |
Who has copies? |
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Will |
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Durable Power of Attorney |
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Health Care Power of Attorney |
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Living will |
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Mortgage |
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Safe deposit box |
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Who has key? |
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Deed to home |
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Birth certificates |
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Marriage certificate |
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Income tax records |
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Car title |
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Unpaid bills |
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Insurance Policies |
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Policy Type |
Name on policy |
Insurer |
Account number |
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Health insurance |
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Medicare |
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Car insurance |
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Life insurance |
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Annuities |
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Financial Accounts |
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Account Type |
Name on Account |
Institution |
Account Number |
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Include savings, checking, credit card, IRA,
stocks/bonds, mutual funds, retirement accounts and other financial holdings.