Personal Records - Caregivers Library

Personal Records

A fo r m t o h e lp y o u k e e p t r a ck o f y o u r lo v e d o n e 's p e r s o n a l r e co r d s a n d o t h e r im p o r t a n t inform a tion.

Personal Records and I m portant Docum ents of

(your loved one's nam e)

Last W ill and Testam ent

Locat ion:

_________________________________________________________________________

At t orney's nam e/ Phone No.:

_________________________________________________________

D oct or s: Prim ary Care- Nam e/ Phone No.:

____________________________________________________

Other Specialists:

Nam e/ Phone No.: Nam e/ Phone No.:

______________________________________________________________ ______________________________________________________________

Social Security Num ber:

_________________________________________________________

Cont act regarding inform at ion and benefit s:

____________________________________

I nsurance Policies: Locat ion:

___________________________________________________________________

N a m e of I ns Co.

Phone No.

Policy No.

Be n e f icia r y

Value

Burial Policy/ Funeral Plan.

Locat ion:

___________________________________________________________________

Cont act / Phone No.:

___________________________________________________

Ce m e t e r y Pr ope r t y Ownership cert ificat e locat ion:

___________________________________________________

Bir t h Ce r t ifica t e Locat ion: Nam e on Cert ificat e: Dat e of Birt h: ______________ Fat her's Nam e: Mot her's Nam e:

________________________________________________________________________

______________________________________________________________

Cit y/ Count y: ______________________________

State: __________

___________________________________________________________________ ___________________________________________________________________

Marriage Lice n se Locat ion:

________________________________________________________________________

For addit ional t ools for caregiving or aging, visit

Wedding: ________________

Cit y/ Count y: __________________________________ St at e _______

Divorce Records Locat ion: At t or n ey 's Nam e/ Phone:

________________________________________________________________________ ______________________________________________________________

Military Records

Locat ion:

________________________________________________________________________

Milit ary I D No.: ______________________

Veterans Benefits/ I nfo.: ____________________________

Milit ary Ret irem ent Benefit s

( Branch of Milit ary Cont act Phone No.) :

______________________________________________

Asse t s: Che ck ing, Sa vings, CD Account s

Account Num ber Che ck ing Che ck ing Savings Savings CD s

Nam e on Account

Branch Location

Safe Deposit Box Locat ion: Key Locat ion: Cont ent s:

_____________________________________________________________________ ________________________________________________________________

_____________________________________________________________________ _____________________________________________________________________

Retirem ent, 4 0 1 ( k) and/ or I RA Docum ents Cont act / Phone No.: Cont act / Phone No.:

_________________________________________________ _________________________________________________

I n ve st m e n t s--St ock s a n d Bon ds

Locat ion:

_____________________________________________________________________

Deed to House/ Other property and Mortgage I nfo

Locat ion: :

_____________________________________________________________________

Mort gage Co. Nam e/ Policy No.:

_________________________________________________

Cont act / Phone No.:

_________________________________________________

Autom obile Ow nership Tit le( s) Locat ion:

________________________________________________________________

Vehicle I D No.

Year

Make

Model

Other Vehicle ( truck, m otor hom e, boat)

Tit le( s) Locat ion:

________________________________________________________________

Vehicle I D No.

Year

Make

Model

Other Assets

Descr ipt ion :

_____________________________________________________________________

Locat ion of I m port ant Docum ent s:

_________________________________________________

For addit ional t ools for caregiving or aging, visit

Debts

Cr e dit Ca r ds Locat ion:

Cr e dit Ca r d Co.

_____________________________________________________________________

Nam e on Account

Account No.

Cont a ct Phon e N o.

Lo a n s Type of Loan

Cont a ct Phon e N o.

Docum ents Located

Tax Records

Locat ion:

_____________________________________________________________________

Account ant 's Nam e/ Phone No.:

____________________________________________

? Co p yrigh t Fam ilyCare Am e r ica In c. All Righ ts Re s e rve d .

For addit ional t ools for caregiving or aging, visit

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