Estate Planning Inf o r m a t i o n
Funeral Arrangements
W hich funeral home? H a v e y o u p r e --paid f o r f uneral services? Have you purchased a cem e t e r y l o t o r c r y p t ? W here are services to be held? Of f iciating clergy: D o y o u w ish m ilitary services? D o y o u w ish f r aternal services? W h o t o c o n t a c t r e g a r d i n g m i l i t a r y o r f raternal services: Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ W hat cem et e r y ? Location of deed? Pall bearers: Special arrangem ents: T elephone num ber:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Biographical Information
Y our full name: Y our address:
R esident of t h i s city since: Place of b i r t h : Social Security No.: Employer: Marital status: Date of b i r t h : Occupation: If r e t i r e d , w h a t y e a r r e t i r e d : Name of your spouse:
If y o u r spouse is deceased, w h a t y e a r h e / s h e d i e d : Y o u r f a t h e r 's n a m e : F a t h e r ’s Place of b i r t h : Y ear he w as born:
Y o u r m o t h e r 's m aiden nam e: M o t h e r ’s Place of b i r t h : L i st y o u r c h i l d r e n : Name T elephone Num b e r City Y ear she w as born:
F r a t e r n a l , ser v i c e a n d o t h e r o r g a n i z a t i o n s t o w h i c h y o u b e l o n g :
Military service: L i st f riends and relatives you w ish to be notif ied of y o u r d e a t h : Name R elationship City Phone No.
W here y o u w e r e e d u c a t e d : Y our church or religious af f i l i a t i o n : Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City _ _ _ _ _ _ _ _ _ _ _ Are you a m ember? _
Estate Information
Location of w i l l : Ex ecutor: Name Address
Attorney: Name
Address
A ccountant: Name
Address
B a n k / S a v i n g s & L o a n / C r e d i t U n i o n a c c o u n t s ( i n c l u d i n g c e r t i f i c a t e s o f d eposit): Account number Institution Branch
L i f e Insurance Policies: Policy number
C o m pany
L o c a t i o n o f Policy
Stock, Bonds, M u t u a l F u n d s , Securities: N o . Shares/ A m o u n t C o m pany
W here Located
R eal estate ow n ed: Description of P r o p e r t y Located
W here Deed is
V ehicles Ow n ed: License No.
Y ear/ M a k e
Location of T i t l e
L o c a t i o n o f d o c u m ents: M i l i t a r y d i s c h a r g e c e r t i f i cate:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Marriage certif i cate: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Incom e t a x r e t u r n s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Broke r s:
Pension, R etirem ent IR A , K eogh, other benef i t s pay a b l e o n d e a t h :
Saf ety Deposit Box :
W here located:
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