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Organization Personal Affairs
This simple form organizes the many details and forms needed when we begin to assist our loved one, such as birth and death certificates, insurance information, etc. Have your loved one complete this form. You may also complete one for yourself and give it to someone you trust. 1. Safe deposit box: a. Location: ____________________________________________ b. Account number: ______________________________________ c. Location of key: _______________________________________ d. Name on account: _____________________________________
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2. Safe: a. Location: ____________________________________________ b. Combination: _________________________________________
3. Birth certificate: Never give the original away. If an original is required by someone, get a notarized copy and retain the original.
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a. Name/Original Location: ____________________________________________________ b. Name/Original Location: ____________________________________________________ c. Name/Original Location: ____________________________________________________ d. Name/Original Location: ____________________________________________________
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4. Citizenship or residency papers: Never give the original away. If an original is required by someone, get a notarized copy and retain the original. a. Name/Original location: ____________________________________________________ b. Name/Original location: ____________________________________________________ c. Name/Original location: ____________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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5. Children’s birth certificates: Never give the original away. If an original is required by someone, get a notarized copy and retain the original. a. Name/Original Location: ___________________________________________________ b. Name/Original Location: ___________________________________________________ c. Name/Original Location: ___________________________________________________ d. Name/Original Location: ___________________________________________________ e. Name/Original Location: ___________________________________________________
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6. Marriage certificate: Never give the original away. If an original is required by someone, get a notarized copy and retain the original.
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a. Name/Original Location: ___________________________________________________ b. Name/Original Location: ___________________________________________________ 7. Divorce certificate: Never give the original away. If an original is required by someone, get a notarized copy and retain the original.
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a. Name/Original Location: ___________________________________________________ b. Name/Original Location: ___________________________________________________
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8. Death certificate: Never give the original away. If an original is required by someone, get a notarized copy and retain the original. a. Name/Original Location: ___________________________________________________ b. Name/Original Location: ___________________________________________________ c. Name/Original Location: ___________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
9. Military/Veteran documents:
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Service Number: _____________________________________________
Served where? (overseas) ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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10. Education records: a. Name/Original Location: _____________________________________________________ b. Name/Original Location: _____________________________________________________ c. Name/Original Location: _____________________________________________________ d. Name/Original Location: _____________________________________________________
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11. Employment Contracts: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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12. Partnership Agreements: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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13. Funeral arrangements: a. Mortuary (name, address, phone): _____________________________________________________ _____________________________________________________ _____________________________________________________ b. Burial site (name, address, phone): _____________________________________________________ _____________________________________________________ _____________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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c. Cremation plans: _____________________________________________________ _____________________________________________________ _____________________________________________________ d. Payment details: _____________________________________________________ _____________________________________________________ _____________________________________________________ e. Clergy contact information: _____________________________________________________ _____________________________________________________ _____________________________________________________ 14. Ownership Deeds and Titles: Institution
Phone
Current value
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Home
Business
Address
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Car
Account #
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
15. Insurance
Car
Health
Life
Phone
Location of documents
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Home
Longterm care
Address
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Disability
Account #
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Institution
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Critical care
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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16. Other important items (valuables, jewelry, artwork etc.) and their location: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
17. Names and current addresses of spouse, partner, children or other beneficiaries: Relationship Address
Phone
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Name
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18. Animal information including type, name, veterinary information, medications and contact information for who will care for animals in your absence: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
19. Email accounts and other on-line memberships: Password
Membership
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20. Other information: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.