Organizing Your Personal Affairs

Organizing Your Personal Affairs

______ABOUT YOU______

Your legal name______

Address______

City______State______Zip Code______

Date of birth______Place of birth______

City______State______Zip Code______

Your citizenship______Your race______

Your religious affiliation______

Occupation or former occupation (kind of work you did most of your life)______

Your education: High School ______College______

Graduate School______Other______

______SIGNIFICANT OTHER______

Marital Status: ___Married ___Divorced ___Widowed ___Other______

Name of spouse______

Spouse’s place of birth______

______FAMILY______

Mother’s maiden name______Her place of birth______

Her address______

City______State______Zip Code______

Father’s name______His place of birth______

His address______

City______State______Zip Code______

______CHILDREN______

Name______Phone______

______GRAND CHILDREN______

Name______Phone______

______SIBLINGS______

Name______Phone______

______GOD PARENTS______

Name______Phone______

______OTHER PERTINENT FAMILY MEMBERS______

Name______Relationship______

Phone______

Name______Relationship______

Phone______

Name______Relationship______

Phone______

Name______Relationship______

Phone______

______MILITARY______

Dates of service______Branch of service______

Rank______Service Number______

Wars/conflicts served: First______Second______

Location of discharge papers (you will need a copy of these papers)______

______FRATERNAL ORGANIZATIONS______

Name______Address______

City______State______Zip Code______

Name______Address______

City______State______Zip Code______

______INSURANCE INFORMATION______

Health Insurance Company______Policy Number______

My policy is located at:______

Life Insurance Company______Policy Number______

My policy is located at:______

Beneficiary______Contingent______

My policy is located at:______

Long Term Care Company______Policy Number______

My policy is located at:______

Annuity Insurance Company______Policy Number______

My policy is located at:______

Disability Insurance Company______Policy Number______

My policy is located at:______

Other Policies: Company______Policy Number______

Amount______Reason Purchased______

My policy is located at:______

______PENSION DETAILS______

Name of Company______Phone______

Type (401k, RRSPs, RRIFs, etc.)______

Value______Other______

Name of Company______Phone______

Type (401k, RRSPs, RRIFs, etc.)______

Value______Other______

______CREDIT CARDS______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

Card Type______Expiration Date______

Additional Card Holder______Relationship______

Telephone Number of Additional Card Holder______

______SAFETY DEPOSIT BOX______

I have a Safety Deposit Box? ___Yes ___No Box Number______

It is located at______Contact Number______

Additional Key Holder______Contact Number______

In the event of no Additional Key Holder the contents of the box is to be opened by:

______Contact Number______

______FINANCIAL INSTITUTIONS______

Savings Account Location (Name of Bank)______

Name of Joint Account Holder______Phone______

Savings Account Location (Name of Bank)______

Name of Joint Account Holder______Phone______

Checking Account Location (Name of Bank)______

Name of Joint Account Holder______Phone______

Checking Account Location (Name of Bank)______

Name of Joint Account Holder______Phone______

______POWER OF ATTORNEY______

I have a will: ___Yes ___No

It is located at name/place:______Phone:______

City______State______Zip Code______

My attorney’s name is:______Phone:______

City______State______Zip Code______

The executor of my Will is:______Phone:______

City______State______Zip Code______

I have a living will: ___Yes ___No

It is located at:______

City______State______Zip Code______

I have a medical Power of Attorney: ___Yes ___No

It is located at:______

City______State______Zip Code______

The person designated under my Medical Power of Attorney is:______

Address______Phone:______

City______State______Zip Code______

______FUNERAL ARRANGEMENTS______

I have already made my funeral arrangements: ___Yes ___No

I wish to have my body: ____Buried (at______) ____Cremated (given

to______) ____Donated (to______)

I would like a: __Traditional Funeral __Direct Burial __Direct Cremation __Other(______)

I would like my ceremony to be: ___Religious ___Personalized ___Military ___Other______

I wish to have my funeral handled by:______

Phone______Address______

City______State______Zip Code______

I want my Viewing/Funeral to be: ___Open Casket ____Closed Casket ____Other______

I would like my service to be conducted by:______

Phone______

I would like my eulogy to be conducted by:______

Phone______

I would like to request the following people as Pallbearers:

Name______Phone______

I would like to be buried wearing______

I would prefer to be buried wearing my jewelry: ___Yes ___No

I would like to have the following songs played at my funeral:______

______

In honor of my memory I would prefer: ____Flowers be sent to the Funeral Home

___ Donations to be made to:______Other:______

Special Instructions:______

______ORGAN DONATION INFORMATION______

Are you an Organ Donor: ___Yes ___No

If it is at all possible I would like to have the following organs donated: _____None ____All

___Heart ___Liver ___Kidney ___Lung ___Pancreas ___Intestine ___Cornea

___Skin ___Bone ___Bone Marrow ___Eyes ____Other:______

Donor______Date______

Witness______Date______

______COPIES OF THIS DOCUMENT______

Copies of this document have been probated: ___Yes ___No

Copies of this document are kept by the following people:

Name______Phone______

Address______City______State______Zip______

Name______Phone______

Address______City______State______Zip______

Name______Phone______

Address______City______State______Zip______

Name______Phone______

Address______City______State______Zip______

Name______Phone______

Address______City______State______Zip______

HOW I WOULD LIKE MY HEADSTONE, FOOTSTONE,

& OBITUARY TO READ

The following should be followed:

___Exactly ___As a guideline ___At discretion ___Does not matter

Headstone:

______

Footstone:

______

Obituary:

______

______SPECIFIC CONTACTS AT THE TIME OF PASSING VIA PHONE______

Call:(name)______At (phone)______

Tell them:______

______

Tell them to contact______At (phone)______

Call:(name)______At (phone)______

Tell them:______

______

Tell them to contact______At (phone)______

Call:(name)______At (phone)______

Tell them:______

______

Tell them to contact______At (phone)______

Call:(name)______At (phone)______

Tell them:______

______

Tell them to contact______At (phone)______

Call:(name)______At (phone)______

Tell them:______

______

Tell them to contact______At (phone)______

______SPECIFIC CONTACTS AT THE TIME OF PASSING VIA MAIL______

Name______Address______

City______State______Zip______

I already have a letter written for them: ___Yes ___No

If Yes it is located______

If No, Please write______

______

Name______Address______

City______State______Zip______

I already have a letter written for them: ___Yes ___No

If Yes it is located______

If No, Please write______

______

Name______Address______

City______State______Zip______

I already have a letter written for them: ___Yes ___No

If Yes it is located______

If No, Please write______

______

______CONFIDENTIAL______

THE FOLLOWING INFORMATION IS CONSIDERED PERSONAL & CONFIDENTIAL, THEREFORE IT IS TO ONLY BE VIEWED BY THE INTENDED RECIPIENT

This letter is intended solely for______

of (address)______(city)______(state)______(zip)______

______

PUBLIC LETTER TO ALL IN ATTENDANCE AT MY FUNERAL FROM, ME

______

I would like for the fore mentioned letter to be read aloud at my service by______,

or, if they are unavailable ______. Thank you in advance for complying with my wishes.

Sincerely,

______MY PERSONNAL INFORMATION______

Favorite Bible Verse______

Favorite Song______

Favorite Holiday______

Favorite Place______

Favorite Color______

Most Important Event in My Life______

Saddest Day of My Life______

Favorite Saying______

Lucky Number(s)______

Hobbies______

______

Most Prized Possession______

Best Friend(s)______

Accomplishments______

Favorite Charity______

Greatest Goal______

Favorite Movie______

Favorite TV Show______

Favorite Actor/ Actress______

Favorite Car______

Other Things of Personal Interest______

______

______AUTOMOBILE/ VEHICLE DETAILS______

Vehicle Model______Year______

Vehicle Identification Number______Tag______

Ownership Status: ___Own ___Leased ___Financed to Own

Leasing/ Finance Company______Phone______

Date of End of Lease/ Finance Period______Monthly Payment______

Co-owners Name______Phone______

Insurance Name______Policy Number______

Notes______

Vehicle Model______Year______

Vehicle Identification Number______Tag______

Ownership Status: ___Own ___Leased ___Financed to Own

Leasing/ Finance Company______Phone______

Date of End of Lease/ Finance Period______Monthly Payment______

Co-owners Name______Phone______

Insurance Name______Policy Number______

Notes______

Vehicle Model______Year______

Vehicle Identification Number______Tag______

Ownership Status: ___Own ___Leased ___Financed to Own

Leasing/ Finance Company______Phone______

Date of End of Lease/ Finance Period______Monthly Payment______

Co-owners Name______Phone______

Insurance Name______Policy Number______

Notes______

______IMPORTANT DOCUMENTS LOCATIONS______

Lock Box and/or Other Important Keys______

Birth Certificate(s)______

Children’s Birth Certificate(s)______

Marriage Certificate(s)______

Divorce Decree______

Adoption Papers______

Deeds and Titles______

Mortgages and Notes______

Income Tax Records/Returns______

Veteran Discharge Papers______

Other Important Papers (Please List)______

______

______PROFESSIONAL DIRECTORY______

Name______Profession______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

Name______Profession______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

______MEDICAL DIRECTORY______

Physician’s Name______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

Specialist’s Name______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

Chiropractor’s Name______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

Dentist’s Name______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Notes______

______PET DETAILS______

Name______Type______

This pet has papers: __Yes ___No The papers are located______

Pet to go to______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Veterinarian’s Name______Phone______

Allergies______

Feeding Schedule______Vaccination Schedule______

Has the pet been spade, or neutered? ____Yes ____No

Name______Type______

This pet has papers: __Yes ___No The papers are located______

Pet to go to______

Address______

City______State______Zip______

Phone______Fax______E-mail______

Veterinarian’s Name______Phone______

Allergies______

Feeding Schedule______Vaccination Schedule______

Has the pet been spaded, or neutered? ____Yes ____No

Special Instructions______

______

______MEDICAL HISTORY______

1). Parents and/or siblings had heart disease, kidney disease, diabetes, cancer, stroke, or any other hereditary disease? ( If yes, indicate family member, illness, age at onset, if applicable, age at death.)

___No ___Yes ______

2). Have you had problems with your circulatory, cerebrovascular or cardiovascular systems or blood vessels (such as: heart attack, heart disease, palipitations, heart murmur, chest pain, high blood pressure, stroke, anemia)?

___No ___Yes ______

3). Have you had problems your with nose, throat, lung or respiratory system (emphysema, asthma, shortness of breath, chronic cough or sleep apnea)?

___No ___Yes ______

4). Have you had problems with stomach, intestine, rectum, liver or pancreas (such as: hepatitis, ulcer, colitis, Crohn’s disease, or pancreatitis)?

___No ___Yes ______

5). Have you had problems with your nervous system (such as: epilepsy, seizures, multiple sclerosis, depression, suicide, eating disorder, dementia, Alzheimer’s, anxiety, mental illness)?

___No ___Yes ______

6). Have you had problems with your Endocrine system, bones, muscles, joints, eyes or skin (such as: diabetes, thyroid, lupus, arthritis, or back problems)?

___No ___Yes ______

7). Have you had Cancer, tumor(s), polyps, melanoma or any other malignancy?

___No ___Yes ______

8). Have you had problems with your sugar, albumin or blood in urine, or other illness or disease of the kidneys, bladder, or urinary system, prostate, breast, sexually transmitted disease, or any other reproductive disorder?

___No ___Yes______

9). Other than listed above are there any other pertinent health problems that your family should be aware of in your health history?

___No ___Yes ______

______NOTES______

______

I hope this helps you with your clients and helps you make more sales.

Feel free to copy and use it freely. If you can add something better to it or make it better, then send me a copy of it back to me.

FREE AGENT RESOURCE WEBSITE

Mark Rosenthal
Field Marketing Director
Rosenthal Financial Services
R.F.S. means Real Fast Service
7179 Jonesboro Road Suite 202
Morrow, Georgia 30260 - Check out what I can offer you.
(770) 968-5757 office
1-877-968-5757 toll free
(770) 968-2657 fax