Personal Records and Important Documents of

________________________________________________
(name)
  
Last Will and Testament       
Location: _________________________________________________________
Attorney’s name/Phone No.: ___________________________________________________________________ 
  
Doctors:           
Primary Care
Name/Phone No.: _________________________________________________ 

Other Specialists:         
Name/Phone No.: 
___________________________________________________________________ 

Name/Phone No.:
 ___________________________________________________________________ 

Social Security Number: ____ - ____ - ____ 
Contact regarding information and benefits: ___________________________________________________________________ 

Insurance Policies:                       
Location: _________________________________________________________ 

Name of Ins. Co	Phone No.	Policy No.	Beneficiary	Value	

					
      
Burial Policy/Funeral Plan.                     
Location: ___________________________________________________________________ Contact/Phone No.: ________________________________________________________
  
Cemetery Property                       
Ownership certificate location: _____________________________________________________________________________ 
Birth Certificate                       
Location: ___________________________________________________________________
Name on Certificate: ________________________________________________________
Date of Birth: _____________ City/County: _______________________State: ______
Father’s Name: _____________________________________________________________
Mother’s Name: ____________________________________________________________

Marriage License                         
Location: ________________________________________________________
Wedding: _____________ City/County: _______________________State: ________

Divorce Records                         
Location: ___________________________________________________________________
Attorney’s Name/Phone: ____________________________________________________ 
  
Military Records                       
Location: ___________________________________________________________________
Military ID No.: _____________  Veterans Benefits/Info.: Yes____ No____
Military Retirement Benefits
(Branch of Military Contact Phone No.): 
________________________________________
________________________________________
________________________________________

Assets: 
Checking, Savings, CD Accounts                   
	Account	Number Name on Account	Branch Location	
Checking				
Checking				
Savings				
Savings				
CDs				

Safe Deposit Box 
Location:_________________________________________________________________________
Key Location: ____________________________________________________________________
Contents _________________________________________________________________________
 
Retirement, 401(k) and/or IRA Documents           
Contact/Phone No.: ______________________________________________________________
Contact/Phone No.: ______________________________________________________________
  
Investments—Stocks and Bonds   
Location: ________________________________________________________________________
 
Deed to House/Other property and Mortgage Info 
Location: ________________________________________________________________________
Mortgage Co. Name/Policy No.: __________________________________________________
Contact/Phone No.: ______________________________________________________________

Automobile Ownership
Title(s) Location: ________________________________________________________________

Vehicle ID No.	Year	Make Model	

			

Other Vehicle (truck, motor home, boat) 
Title(s) Location: ________________________________________________________________
      
Vehicle ID No.	Year	Make Model	

			
  
Other Assets 
Description
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Location of Important Documents: _________________________________________________________________________________
  
Debts 
Credit Cards:  Yes ___  No ___Location:___________________________________________

Credit Card Co.	Name on Account	Account No.	Contact Phone No.	

				

				

Loans 
Type of Loan.	Contact Phone No.	Documents Located	

			

Tax Records 
Location: _________________________________________________________________________________
Accountant’s Name/Phone No.:
________________________________________
________________________________________
________________________________________

Form adapted from FamilyCareAmerica website http://www.familycareamerica.com/