CONTENTS



FAMILYEMERGENCYHANDBOOKCONTENTSEMERGENCY INFORMATION EMERGENCY CONTACTS & EMERGENCY NUMBERSHOME FLOOR PLAN ( HOUSE PLANS FOR EACH PROPERTY) HOME UTILITIES & CONTACT NUMBERSFAMILY INFORMTIONFAMILY MEMBER INFORMATIONMEDICAL INFORMATION & CONSENT FORM To Whom It May Concern: FAMILY PHYSICIAN LAWYERPERSONS TO NOTIFY UPON DEATH FUNERAL / BURIAL INSTRUCTIONS PERSONAL HISTORYLETTER OF INSTRUCTIONCOPY OF WILLCOPY OF TRUSTBIRTH CERTIFICATESMILITARY PAPERSMARRIAGE CERTIFICATEDIVORCE / SEPERATION PAPERSPASSPORTS(THIS INFORMATION WILL BE IN ANOTHER BOOKLET)FINANCESBANK ACCOUNTSSAFE DEPOSIT BOX CREDIT CARDSSTOCKS AND BONDSOTHER ASSETSSOCIAL SECURITY / CARDRETIREMENT PLANLOAN INFORMATION / AGREEMENTS INCOME TAX RETURNSPROPERTIESREAL ESTATEPAPERS / DISCRIPTIONSIMPROVEMENT RECEIPTSTAX RECEIPTSVEHICLE INFORMATION / OWNERSHIP AUTORVFARM EQUIPMENTLICENSE / REGISTRATIONINSURANCELIFE INSURANCEHEALTH AND MAJOR MEDICALDISABILITY PROPERTYAUTO INSURANCEEMERGENCY CONTACTS AND INFORMATIONFIRE DEPARTMENT # 911____________________________POLICE # 911________________________________LOCATION OF UTILITIES SHUT OFF: REFER TO HOME FLOOR PLAN ON PAGE 7AMBULANCE ____________________________ HOSPITAL_______________________________________DOCTOR _______________________________________________ PHONE # __________________________PHARMACY ____________________________________________ PHONE # __________________________EMERGENCY CONTACTSRELATIVE / FRIEND ________________________________ PHONE #______________________ADDRESS ___________________________________________ CELL#_________________________________RELATIVE / FRIEND ________________________________ PHONE #______________________ADDRESS___________________________________________ CELL #_________________________________EXTRA HOUSE KEY LOCATION __________________________________________________________________NEIGHBOR(S)NAME________________________________________________ NAME_____________________________________________________ADDRESS______________________________________________ ADDRESS__________________________________________________PHONE #_________________ CELL #____________________ PHONE #____________________ CELL #_____________________NEIGHBORHOOD CAPTAIN ___________________________________________PHONE #____________________NEIGHBORHOOD CAPTAIN ASSISTANT__________________________________PHONE #____________________BISHOP / CLERGY___________________________________________ HOME PHONE # ____________________RELIEF SOCIETY PRES______________________________________ HOME PHONE # ______________________ HOME TEACHER ___________________________________________ HOME PHONE # ____________________HOME TEACHER ___________________________________________ HOME PHONE # ____________________VISITING TEACHER ________________________________________ HOME PHONE # _____________________VISITING TEACHER ________________________________________ HOME PHONE # _____________________DENTIST ____________________________________________________ PHONE # ____________________ORTHODONTIST ____________________________________________ PHONE # ___________________ALARM COMPANY ___________________________________________ PHONE # ___________________ELECTRICIAN ________________________________________________ PHONE # ___________________PLUMBER ____________________________________________________ PHONE # ___________________ALARM COMPANY ____________________________________________ PHONE # ___________________AIR / HEATING CO ____________________________________________ PHONE # ___________________APPLIANCE REPAIR __________________________________________ PHONE # ___________________YARD CARE __________________________________________________ PHONE # ___________________GARBAGE PICK UP ___________________________________________ PHONE # ___________________ANIMAL CAREVETERINARIAN ______________________________________________ PHONE # ___________________ANIMALS______________________________________________ TAG # ______________________IMMUNIZATION RECORD ______________________________________________________ANIMALS______________________________________________ TAG # ______________________IMMUNIZATION RECORD ______________________________________________________ANIMALS______________________________________________ TAG # ______________________IMMUNIZATION RECORD ______________________________________________________ANIMALS______________________________________________ TAG # ______________________IMMUNIZATION RECORD ______________________________________________________ANIMALS______________________________________________ TAG # ______________________IMMUNIZATION RECORD ______________________________________________________PLAN WHERE TO MEET IF ANY DISASTEROR EMERGENCY OCCURS(An out of area contact would be important to listin case phone lines are compromised in your area)Emergency Contacts/Important Phone NumbersOut of Area contact:In the event of an emergency our family status can be coordinated through:NameCell/ PhoneRelationAddressIn the event of an emergency where my children need a place to stay, care will be provided for them by the following:NameCell/PhoneRelationAddressHomeFloor Plan1371600189230Each Owned PropertyAll LevelsOutside and InsideWater valve, Gas meter, and Electric meterSprinkler system turn-off valve Outside sewer access if anyHOUSE FLOOR PLANS ANDEMERGENCY SHUT OFF(S) FOR UTILITIESMARK THESE AREAS ON YOUR FLOOR PLAN MAP(make copy for each property owned)40005006724651531620672465Home Utilities53721001111252802255195580Home UtilitiesLights, Gas, Power, Phone, WaterAccount numbers,4343400146685Emergency numbersCell PhoneYour cell phone number(s)Phone number of Service Provider incase of lost or stolen cell phone.Home UtilitiesElectric Company_____________________________ Acct. #_____________Name on Account _____________________________ Phone #___________Gas Company_________________________________ Acct #_____________Name on Account_____________________________ Phone #___________Water Company ______________________________Acct #_____________Name on Account _____________________________ Phone #___________Telephone Company __________________________Acct # _____________Name on Account ____________________________ Phone # ____________Cell Phone Company__________________________ Acct # _____________Name on Account ____________________________ Phone # ____________Alarm Company ______________________________ Acct # _____________Name on Account ____________________________ Phone # ____________FAMILYMEMBERINFORMATIONFAMILY MEMBER INFORMATION: (you can paste photos of each family member here)FAMILY MEMBER Name: _________________________________________Blood Type_____________ Birth date: ______________ Employer or School:Age:________ Sex ________ ______________________________________ Height:________________ Contact:_______________________________Weight:________________ Phone: ________________________________Hair Color: _____________ Physician:______________________________Eye Color_______________ Phone: _________________________________Medications: Special Medical Conditions: FAMILY MEMBER Name: ___________________________________________Blood Type____________ Birth date: ______________ Employer or School:Age:________ Sex: _______ ______________________________________ Height:________________ Contact:_______________________________Weight:________________ Phone: ________________________________Hair Color: _____________ Physician:______________________________Eye Color: ______________ Phone: _________________________________Medications: Special Medical Conditions: FAMILY MEMBER Name: ___________________________________________Blood Type___________ Birth date: ______________ Employer or School:Age:________ Sex: ________ ______________________________________ Height:________________ Contact:_______________________________Weight:________________ Phone: ________________________________Hair Color: _____________ Physician:______________________________Eye Color: _______________ Phone: _________________________________Medications: Special Medical Conditions: FAMILY MEMBER INFORMATION:FAMILY MEMBER Name: __________________________________________Blood Type____________ Birth date: ______________ Employer or School:Age:________ Sex:________ ______________________________________ Height:________________ Contact:_______________________________Weight:_________________ Phone: ________________________________Hair Color: ______________ Physician: ______________________________Eye Color: _______________ Phone: _________________________________Medications: Special Medical Conditions: FAMILY MEMBER Name: ___________________________________________Blood Type___________ Birth date: ______________ Employer or School:Age: ________ Sex: ________ ______________________________________ Height:________________ Contact:_______________________________Weight:________________ Phone: ________________________________Hair Color: _____________ Physician:______________________________Eye Color ____________________ Phone: _________________________________Medications: Special Medical Conditions: FAMILY MEMBER Name:___________________________________________ Blood Type___________ Birth date: ______________ Employer or School:Age: _______ Sex: ________ ______________________________________ _Height:________________ Contact: _______________________________Weight:________________ Phone: ________________________________Hair Color: _____________ Physician: ______________________________Eye Color: ______________ Phone: _________________________________Medications: Special Medical Conditions: MEDICAL2266950102235Consent Forms To Whom It May Concern:FAMILYPHYSICIANLAWYERConsent For EmergencyTreatment and / or Surgery(SHOULD HAVE A FORM FOR EACH MEMBER OF FAMILY)We hereby authorize_______________________________________________________To consent to medical treatment and / or surgery for our minor child____________________________________________________________ date of birth ____ ____ ____ month day year effective from ________________________to _______________________. date date _______________________________________________________________________ Signature of Parents /GuardianPhysician ____________________________________________ Phone # _______________Physician ____________________________________________ Phone # _______________Physician ____________________________________________ Phone # _______________Physician ____________________________________________ Phone # _______________Check with the local hospital to see what is required.TO MY FAMILY, MY PHYSICIAN, MY LAWYER,AND ALL OTHERS WHOM IT MAY CONCERN (SHOULD HAVE A COPY FOR EACH ADULT MEMBER OF THE FAMIY)If the time comes when I can no longer take part in decisions for my own future, let thisstatement stand as an expression of my wishes and directions, while I am still of sound mind.If at such a time the situation should arise in which there is no reasonable expectation of myrecovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by medication, artificial means or “heroic measures”. I do, however, ask that medication be mercifully administered to me to alleviate suffering even though this may shorten my life. This statement is made after careful consideration and is in accordance with my strong convictions and beliefs. I want the wishes and directions here expressed carried out to the extent permitted by law. Insofar as they are not, legally enforceable. I hope that those to whom this will is addressed will regard themselves as morally bound by these provisions.Signed ____________________________Date ___________________________Witness ________________________Witness ________________________Copies of this request have been given to _____________________________________ ____________________________________________ ____________________________________________ ____________________________________________PERSON TO NOTIFY UPON MY DEATHNAME ________________________________________________ RELATIONSHIP __________________________________ADDRESS ______________________________________________ PHONE # _______________________________________ ______________________________________________ CELL # _________________________________________ NAME ________________________________________________ RELATIONSHIP __________________________________ADDRESS ______________________________________________ PHONE # ______________________________________ ______________________________________________ CELL # ________________________________________ NAME ________________________________________________ RELATIONSHIP __________________________________ADDRESS ______________________________________________ PHONE # _______________________________________ _______________________________________________ CELL # _________________________________________ NAME _________________________________________________ RELATIONSHIP __________________________________ADDRESS _______________________________________________ PHONE # _______________________________________ _______________________________________________ CELL # _________________________________________ NAME ________________________________________________ RELATIONSHIP ___________________________________ADDRESS ______________________________________________ PHONE # _______________________________________ ______________________________________________ CELL # _________________________________________NAME _________________________________________________ RELATIONSHIP __________________________________ADDRESS _______________________________________________ PHONE # _______________________________________ _______________________________________________ CELL # _________________________________________NAME _________________________________________________ RELATIONSHIP __________________________________ADDRESS _______________________________________________ PHONE # _______________________________________ _______________________________________________ CELL # _________________________________________NAME __________________________________________________ RELATIONSHIP ___________________________________ADDRESS ________________________________________________ PHONE # ________________________________________ ________________________________________________ CELL # __________________________________________NAME ________________________________________________ RELATIONSHIP ____________________________________ADDRESS ____________________________________________ PHONE # ________________________________________ _____________________________________________ CELL # __________________________________________ NAME ________________________________________________ RELATIONSHIP _______________________________ADDRESS ______________________________________________ PHONE # ___________________________________ _______________________________________________ CELL # ______________________________________ NAME ________________________________________________ RELATIONSHIP _______________________________ADDRESS ______________________________________________ PHONE # ____________________________________ ______________________________________________ CELL # ______________________________________NAME _________________________________________________ RELATIONSHIP _______________________________ADDRESS _______________________________________________ PHONE # ____________________________________ _______________________________________________ CELL # ______________________________________ NAME ________________________________________________ RELATIONSHIP _______________________________ADDRESS ______________________________________________ PHONE # ____________________________________ ______________________________________________ CELL # ______________________________________NAME ________________________________________________ RELATIONSHIP ________________________________ADDRESS ______________________________________________ PHONE # ____________________________________ ______________________________________________ CELL # ______________________________________NAME _________________________________________________ RELATIONSHIP ________________________________ADDRESS _______________________________________________ PHONE # _____________________________________ _______________________________________________ CELL # _______________________________________ NAME _________________________________________________ RELATIONSHIP ________________________________ADDRESS _______________________________________________ PHONE # _____________________________________ _______________________________________________ CELL # _______________________________________ NAME _________________________________________________ RELATIONSHIP ________________________________ADDRESS _______________________________________________ PHONE # _____________________________________ ________________________________________________ CELL # _______________________________________ PERSONAL INFORMATIONANDINSTRUCTIONS FORFUNERAL AND BURIALPERSONAL HISTORY(SHOULD HAVE A COPY FOR EACH MEMBER OF THE FAMILY)NAME _________________________________________ MAIDEN_______________________________________________ SINGLE _______MARRIED ______WIDOWED ______DIVORCED ______DATE OF BIRTH _______ ______ _______ BIRTH PLACE _________________________________________________MONTH DAY YEARNAME OF SPOUSE _____________________________________________________________________________________ADDRESS_____________________________ PREVIIOUS ADDRESS______________________________________ _______________________________________ ___________________________________________________________FATHER’S NAME ______________________________________________________________________________________MOTHER’S NAME ___________________________________________MAIDEN __________________________________CHILDREN:___________________________________________ _____________________________________________________________________________________ ______________________________________________________________________________________ ___________________________________________ ___________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ___________________________________________BROTHERS AND SISTERS___________________________________________ ______________________________________________________________________________________ ___________________________________________ ___________________________________________ ______________________________________________________________________________________ ___________________________________________DATEMAJOR ILLINESS/SURGERY ATTENDING PHYSICIAN(S)_________ ___________________________________ ____________________________________________________ ___________________________________ ____________________________________________________ ___________________________________ ___________________________________________BLOOD TYPE ________________________________PRESCRIPTIONS / MEDICATIONS:__________________________________ ___________________________________ ________________________________________________________________ ___________________________________ ______________________________SCHOOLS ATTENDED:______________________________________ ______________________ ______________ ____________HIGH SCHOOL CITY STATE DATE________________________________________________ _____________________________ _________________ _______________COLLEGE CITY STATE DEGREE/DATE________________________________________________ _____________________________ _________________ _______________OTHER CITY STATE DEGREE/DATEMISSIONARY SERVICE _______________________________________ _____________ NAME OF MISSION DATE TO DATEMILITARY SERVICE__________________________________SERIAL # _______________ BRANCH ENLISTMENT DATE ____ ____ _____ DISCHARGE DATE _____ _____ _____ RANK ____________ MO DAY YEAR MO DAY YEAROCCUPATION _______________________________________________________________EMPLOYER _________________________ PHONE #___________________________ADDRESS _________________________ _________________________SPECIAL RECOGNITIONS/ OTHER INFORMATION ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________FUNERAL AND BURIAL INSTRUCTIONS(SHOULD HAVE INSTRUCTIONS FOR EACH MEMBER IN FAMILY)THESE ARE THE WISHES OF ______________________________________________________BISHOP OR INDIVIDUAL TO OFFICIATE______________________________________________ PHONE ______________________________________________________________________ PHONE ________________________FUNERAL HOME PREFERRED _____________________________________________________LOCATION OF SERVICE__________________________________________________________LOCATION OF BURIAL ___________________________________________________________________ I HAVE PURCHASED A CEMETARY PLOTCEMETARY __________________________ ADDRESS ________________________________LOT # ______________ BLOCK # _________________ SECTION ________________________________ I HAVE A PREPAID FUNERAL PLAN #VIEWING WISHES: OPEN CASKET ___________ CLOSED CASKET ___________REQUEST FOR FUNERAL SERVICE;PRAYERS SPEAKERSFAMILY_________________________________ LIFE SKETCH____________________________________OPENING ______________________________ _________________________________________________CLOSING ______________________________ _________________________________________________DEDICATORY __________________________ _________________________________________________MUSIC / HYMNS ________________________ BY ______________________________________________________________________________________ BY ______________________________________________________________________________________ BY ______________________________________________________________________________________ BY ______________________________________________MILITARY LAST RIGHTS ______ YES ______ NO POST # ___________________________________SPECIAL REQUEST FOR FUNERAL __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PALLBEARERS FOR: ________________________________________________________NAME __________________________________________________________ ACTIVE ____HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME ___________________________________________________________ACTIVE ____HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME __________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS __________________________ __________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS __________________________ __________________________ PHONE _______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS __________________________ __________________________ PHONE _______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ PALLBEARERS FOR: ________________________________________________________NAME ___________________________________________________________ACTIVE ____HONORARY____ADDRESS _________________________ __________________________ PHONE______________________________ NAME ___________________________________________________________ACTIVE ____HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME __________________________________________________________ACTIVE ____ HONORARY____ADDRESS ___________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS __________________________ __________________________ PHONE _______________________________ NAME __________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________NAME _________________________________________________________ACTIVE ____ HONORARY____ADDRESS __________________________ __________________________ PHONE _______________________________ NAME __________________________________________________________ACTIVE ____ HONORARY____ADDRESS ____________________________________________________ PHONE______________________________ LETTER OF INSTRUCTION(A COPY SHOULD BE ATTACHED TO THE ORIGINAL WILL)IT IS MY DESIRE THAT THE EXECUTOR OF MY ESTATE DISTRIBUTE THE BELOW DESCRIBED ITEMS TO THE RESPECTIVE INDIVIDUALSITEM ____________________________________________________________________________________________INDIVIDUAL _______________________________________________________________________________________ITEM _____________________________________________________________________________________________ INDIVIDUAL _______________________________________________________________________________________ ITEM ______________________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________________ITEM ______________________________________________________________________________________________INDIVIDUAL _________________________________________________________________________________________ ITEM _______________________________________________________________________________________________INDIVIDUAL _________________________________________________________________________________________ ITEM _______________________________________________________________________________________________INDIVIDUAL _________________________________________________________________________________________ ITEM _______________________________________________________________________________________________INDIVIDUAL __________________________________________________________________________________________ ITEM _______________________________________________________________________________________________INDIVIDUAL _________________________________________________________________________________________ ITEM _______________________________________________________________________________________________INDIVIDUAL __________________________________________________________________________________________ DATE _____________ _______ SIGNATURE _____________________________________________________ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL _______________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________I ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________DATE _______________SIGNATURE___________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ ITEM _______________________________________________________________________________________INDIVIDUAL ________________________________________________________________________________ DATE __________ SIGNATURE _______________________________________________________________C O P Y O F W I L L(SHOULD HAVE A COPY FOR EACH MEMBER THIS WOULD APPLY TO)WILL OF ____________________________________________________________________________________LOCATION OF ORIGINAL ___________________________________________________________________DATE OF WILL _____________________________________NAME OF ATTORNEY _______________________________________________________________________ADDRESS __________________________________________________________________________________PHONE _________________________________ CELL ____________________________________________EXECUTOR_________________________________________________________________________________ADDRESS __________________________________________________________________________________PHONE ___________________________________ CELL ___________________________________________ C O P Y O F T R U S T(SHOULD HAVE A COPY FOR EACH MEMBER THIS WOULD APPLY TO)TRUST OF _________________________________________________________________________________LOCATION OF ORIGINAL ___________________________________________________________________DATE OF TRUST ____________________________________NAME OF ATTORNEY _______________________________________________________________________ADDRESS ___________________________________________________________ PHONE ______________NAME OF TRUSTEE ________________________________________________________________________ADDRESS ___________________________________________________________ PHONE ______________FlagsThe colored flags are to be used during an emergency situation. Place in the window or on the door of the home to mark the home. During an emergency your Block Captain will check all homes in the area for reporting to authorities of the condition of the people and structures in his/her assigned area.Green - all is wellYellow- injuries but not life threateningRed- life threatening injuries need medical helpBlue - there is a missing person from this dwellingBlack- there has been a death in this homeOrange- Quarantined, Pandemic, Contagious Green Ribbon - house evacuated, (post flag, on doorknob, for leaving status) FINANCESCONTENTSFINANCES BANK ACCOUNTSSAFE DEPOSIT BOX CREDIT CARDSSTOCKS AND BONDSOTHER ASSETSSOCIAL SECURITY / CARDRETIREMENT PLANLOAN INFORMATION / AGREEMENTS INCOME TAX RETURNSPROPERTIESREAL ESTATEPAPERS / DISCRIPTIONSIMPROVEMENT RECEIPTSTAX RECEIPTSVEHICLE INFORMATION / OWNERSHIP AUTORVFARM EQUIPMENTLICENSE / REGISTRATIONINSURANCELIFE INSURANCEHEALTH AND MAJOR MEDICALDISABILITY PROPERTYAUTO INSURANCENote: A copy of your most recent bank statement should be included in this information (should be replaced each month)BANK ACCOUNTS(FOR ANY MEMBER WITH AN ACCOUNT)ACCOUNT NAME ___________________________________________________________________BANK _________________________________________ ACCOUNT # ________________________ADDRESS __________________________________________________________________________JOINT ______ INDIVIDUAL _____ CHECKING _____ SAVINGS _____THOSE AUTHORIZED TO SIGN ON ACCOUNT: _______________________________________________________________________________ _______________________________________BANK OFFICER TO CONTACT _______________________________________________________LOCATION OF CHECK BOOK / SAVINGS PASSBOOK ______________________________________________________________________________________________________________________ ACCOUNT NAME ___________________________________________________________________BANK _________________________________________ ACCOUNT # ________________________ADDRESS __________________________________________________________________________JOINT ______ INDIVIDUAL _____ CHECKING _____ SAVINGS _____THOSE AUTHORIZED TO SIGN ON ACCOUNT: ______________________________________________________________________________ _______________________________________BANK OFFICER TO CONTACT _______________________________________________________LOCATION OF CHECK BOOK / SAVINGS PASSBOOK ______________________________________________________________________________________________________________________ ACCOUNT NAME ___________________________________________________________________BANK _________________________________________ ACCOUNT # ________________________ADDRESS __________________________________________________________________________JOINT ______ INDIVIDUAL _____ CHECKING _____ SAVINGS _____THOSE AUTHORIZED TO SIGN ON ACCOUNT: ______________________________________________________________________________ _______________________________________BANK OFFICER TO CONTACT _______________________________________________________LOCATION OF CHECK BOOK / SAVINGS PASSBOOK ______________________________________________________________________________________________________________________SAFE DEPOSIT BOXBANK ______________________________________________________________________________ADDRESS __________________________________________________________________________LOCATION OF KEYS ________________________________________________________________PERSONS AUTHORIZED TO SIGN ___________________________________________________CONTENTS :________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________CREDIT CARDSCARD ISSUED BY ________________________________________ PHONE ___________________BILLING ADDRESS __________________________________________________________________CARD # ________________________________ LOCATION OF CARD _______________________THOSE AUTHOIZED TO SIGN ON CARD ___________________________________________________________________________________________________________________________________ CARD ISSUED BY ________________________________________ PHONE ___________________BILLING ADDRESS __________________________________________________________________CARD # ________________________________ LOCATION OF CARD _______________________THOSE AUTHOIZED TO SIGN ON CARD ___________________________________________________________________________________________________________________________________ CARD ISSUED BY ________________________________________ PHONE ___________________BILLING ADDRESS __________________________________________________________________CARD # ________________________________ LOCATION OF CARD _______________________THOSE AUTHOIZED TO SIGN ON CARD ___________________________________________________________________________________________________________________________________ CARD ISSUED BY ________________________________________ PHONE ___________________BILLING ADDRESS __________________________________________________________________CARD # ________________________________ LOCATION OF CARD _______________________THOSE AUTHOIZED TO SIGN ON CARD __________________________________________________________________________________________________________________________________ CARD ISSUED BY ________________________________________ PHONE ___________________BILLING ADDRESS __________________________________________________________________CARD # ________________________________ LOCATION OF CARD _______________________THOSE AUTHOIZED TO SIGN ON CARD ___________________________________________________________________________________________________________________________________ STOCKS AND BONDSFIRM_____________________________________________ BROKER ______________________________________ADDRESS __________________________________________ PHONE _______________________________________ACCOUNT NAME ___________________________________ ACCT # _______________________________________ACCOUNT NAME ___________________________________ ACCT # _______________________________________FIRM_____________________________________________ BROKER _______________________________________ADDRESS __________________________________________ PHONE ________________________________________ACCOUNT NAME ___________________________________ ACCT # ________________________________________ACCOUNT NAME ___________________________________ ACCT # ________________________________________ FIRM_____________________________________________ BROKER _______________________________________ADDRESS __________________________________________ PHONE ________________________________________ACCOUNT NAME ___________________________________ ACCT # ________________________________________ACCOUNT NAME ___________________________________ ACCT # ________________________________________ FIRM_____________________________________________ BROKER _______________________________________ADDRESS __________________________________________PHONE ________________________________________ACCOUNT NAME ___________________________________ ACCT # ________________________________________ACCOUNT NAME ____________________________________ACCT # ________________________________________ FIRM______________________________________________BROKER ______________________________________ADDRESS __________________________________________PHONE _______________________________________ACCOUNT NAME ___________________________________ ACCT # _______________________________________ACCOUNT NAME ___________________________________ ACCT # _______________________________________ FIRM______________________________________________BROKER ______________________________________ADDRESS __________________________________________ PHONE _______________________________________ACCOUNT NAME ____________________________________ACCT # _______________________________________ACCOUNT NAME ___________________________________ ACCT # _______________________________________ OTHER ASSETS (FOR MEMBERS THIS WOULD APPLY TO)INFORMATION REGARDING CERTIFICATES OF DEPOSIT, RETIREMENT PLANS, ANNUITY CONTRACTS, STOCK-OPTION PLANS, PROFIT-SHARING PLANS, LIMITED PARTNERSHIPS, GOLD COINS, ANTIQUES, ART, COLLECTIABLES, ETC….ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ___________________________________________________________________________________________________________ ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET_______________________________________________________________________________________________________ ____________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ ASSET_______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________LOCATION OF INFORMATIOIN PERTAINING TO THIS ASSET____________________________________________________________ ____________________________________________________________________________________________________________ SIGNATURE _______________________________________ DATE ____________________________________________________Social SecurityCardCopyPhone NumberReport if Lost or StolenSocial Security1-208-522-7992 1-800-772-1213ssnumber/Medicare1-800-426-3477 SOCIAL SECURITYSocial Security benefits should be applied for as soon as possible following the death of a wage earner. You will need to take with you the following documents:_____DEATH CERTIFICATE _____MARRIAGE CERTIFICATE_____PREVIOUS DIVORCE PAPERS OF DECEASED_____BIRTH CERTIFICATES OF DECEASED, SPOUSE, CHILDREN, including step-children living in the household of the deceased_______MILITARY DISCHARGE PAPERS_____INCOME TAX RETURNS ---- previous two years_____SOCIAL SECURITY NUMBERS OF DECEASED, SPOUSE CHILDREN, including step- children living in the household of deceasedFULL NAMESOCIAL SECURITY NUMBER_________________________________________ _____________________________________________________________________________________________________________________________ _________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________RETIREMENT PLAN(FOR EACH MEMBER THIS MY APPY TO)NAME OF FUND ______________________________________________________INSTITUTION ADMINISTERING FUND ________________________________ADDRESS ______________________________________ DATE_________________ ______________________________________ AMOUNT IN FUND _____________DATE FUNDS ARE RETRIEVABLE _____________________________________PERSON OR PERSONS FUNDS ARE AVAILABLE TO:__________________________________________________________________________________________________________________________________________LOCATION OF DOCUMENTS PERTAINING TO FUND_________________________________________________________________________________________ADDITIONAL IMFORMATION ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________RETIREMENT PLAN(FOR EACH MEMBER THIS MAY APPLY TO)NAME OF FUND _________________________________________________________________INSTITUTION ADMINISTERING FUND __________________________________________ADDRESS ______________________________________ DATE___________________________ ______________________________________ AMOUNT IN FUND _______________________DATE FUNDS ARE RETRIEVABLE _______________________________________________PERSON OR PERSONS FUNDS ARE AVAILABLE TO:___________________________________ _____________________________________________________________________________________________________________________LOCATION OF DOCUMENTS PERTAINING TO FUND__________________________________________________________________________________________________________________ADDITIONAL IMFORMATION _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________LOAN INFORMATION(INCLUDE PERSONAL LOANS, INSTALLMENT PURCHASES, ETC.)LENDER __________________________________LOAN # ________________________________ADDRESS _________________________________PAYMENT _____________________________ _________________________________DUE DATE ____________________________PHONE # _________________________________ CONTACT ______________________________COLLATERAL USED _____________________________________________________________________________DATE OF LOAN ________________________ DATE OF FINAL PAYMENT __________________________INTREST RATE ________________________ # OF PAYMENTS _______________________________LOCATION OF AGREEMENT ____________________________________________________________________REASON FOR LOAN _____________________________________________________________________________ADDITIONAL INFORMATION __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ LENDER __________________________________LOAN # ________________________________ADDRESS _________________________________PAYMENT _____________________________ _________________________________DUE DATE _____________________________PHONE # _________________________________ CONTACT _______________________________COLLATERAL USED ______________________________________________________________________________DATE OF LOAN ________________________ DATE OF FINAL PAYMENT _______________________INTREST RATE ________________________ # OF PAYMENTS _________________________________LOCATION OF AGREEMENT ______________________________________________________________________REASON FOR LOAN _______________________________________________________________________________ADDITIONAL INFORMATION __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________LENDER __________________________________LOAN # ___________________________________ADDRESS _________________________________PAYMENT ________________________________ _________________________________DUE DATE ________________________________PHONE # _________________________________ CONTACT __________________________________COLLATERAL USED ________________________________________________________________________________DATE OF LOAN ________________________ DATE OF FINAL PAYMENT ______________________________INTREST RATE ________________________ # OF PAYMENTS ___________________________________LOCATION OF AGREEMENT ________________________________________________________________________REASON FOR LOAN _________________________________________________________________________________ADDITIONAL INFORMATION ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________LENDER __________________________________LOAN # ____________________________________ADDRESS _________________________________PAYMENT _________________________________ _________________________________DUE DATE _________________________________PHONE # _________________________________ CONTACT ___________________________________COLLATERAL USED _________________________________________________________________________________DATE OF LOAN ________________________ DATE OF FINAL PAYMENT _______________________________INTREST RATE ________________________ # OF PAYMENTS ____________________________________LOCATION OF AGREEMENT _________________________________________________________________________REASON FOR LOAN __________________________________________________________________________________ADDITIONAL INFORMATION ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________COPY OF MOST RECENT TAX RETURNS WHATPROPERTIESDO YOU OWNREAL ESTATEPROPERTY ADDRESS NAMES OF OWNERS________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________DATE OF PURCHASE _______________________PURCHASE PRICE _______________________MORTGAGE HELD BY _____________________________________________________________________________ADDRESS __________________________________________________________________________________________APPROXIMATE MORTGAGE BALANCE ____________________________________ DATE __________________# OF YEARS ON MORTGAGE _________________INTEREST RATE __________________________LOAN # ______________________________________PAYMENT AMOUNT ______________________DUE DATE ___________________________________LATE PAYMENT __________________________PROPERTY TAXES ___________________________LOCATION OF TITLE / DEED ________________________________________________________________________DESCRIPTION OF MAJOR IMPROVEMENTS ___________________________________________________________DATE ___________ COST __________________ ___________________________________________________________DATE ___________ COST __________________ ___________________________________________________________DATE ___________ COST __________________ __________________________________________________________ DATE ___________ COST ___________________ ___________________________________________________________ DATE ___________COST____________________ ___________________________________________________________DATE____________COST_______________________________________________________________________________DATE____________COST_______________________________________________________________________________DATE____________COST_______________________________________________________________________________DATE____________COST____________________LOCATION OF RECEIPTS ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________VehicleInformationMake, model, year, license plate number and copy of registration and insurance policy of each vehicle in household. Include cars, recreational vehicles, boats, motorcycles, etc.DRIVER’S LICENSECopyPhone NumberReport if Lost or StolenState Transportation DepartmentVEHICLE INFORMATIONMAKE __________________ MODEL ________________________ YEAR _______________MOTOR I.D. # _______________________________________LICENSE # _______________REGISTERED OWNER_________________________________________________________DATE PURCHASED _____________ LOAN CARRIED BY _________________________PHONE # _______________________ ADDRESS ___________________________________TITLE # _________________________ LOCATION OF TITLE _______________________________________________________________________________________________________________________________________________________________________________________MAKE __________________ MODEL ________________________ YEAR ________________MOTOR I.D. # _______________________________________LICENSE # ________________REGISTERED OWNER__________________________________________________________DATE PURCHASED ___________ LOAN CARRIED BY ____________________________PHONE # ______________________ ADDRESS ______________________________________TITLE # _______________________ LOCATION OF TITLE ________________________________________________________________________________________________________________________________________________________________________________________________ MAKE __________________ MODEL ________________________ YEAR _________________MOTOR I.D. # _____________________________________________LICENSE # ___________REGISTERED OWNER___________________________________________________________DATE PURCHASED _______________ LOAN CARRIED BY _________________________PHONE # _________________________ ADDRESS ___________________________________TITLE # ___________________________ LOCATION OF TITLE ____________________________________________________________________________________________________________________________________________________________________________________________ MAKE __________________ MODEL ________________________ YEAR _____________MOTOR I.D. # _______________________________________LICENSE # _____________REGISTERED OWNER_______________________________________________________DATE PURCHASED ___________ LOAN CARRIED BY _________________________PHONE # _______________________ ADDRESS _________________________________TITLE # __________________ LOCATION OF TITLE ______________________________________________________________________________________________________________________________________________________________________________________MAKE __________________ MODEL ________________________ YEAR _____________MOTOR I.D. # _______________________________________LICENSE # _____________REGISTERED OWNER_______________________________________________________DATE PURCHASED ___________ LOAN CARRIED BY _________________________PHONE # _______________________ ADDRESS _________________________________TITLE # __________________ LOCATION OF TITLE ______________________________________________________________________________________________________________________________________________________________________________________ MAKE __________________ MODEL ________________________ YEAR _____________MOTOR I.D. # _______________________________________LICENSE # _____________REGISTERED OWNER_______________________________________________________DATE PURCHASED ___________ LOAN CARRIED BY _________________________PHONE # _______________________ ADDRESS _________________________________TITLE # __________________ LOCATION OF TITLE ______________________________________________________________________________________________________________________________________________________________________________________INSURANCEPOLICIESLIFE INSURANCEINSURED _________________________________________ AMOUNT____________________POLICY # ____________________________ PREMIUM AMOUNT ______________________DUE DATE _________________ BANK DRAFT _______ CHECK _______ OTHER _______MATURITY DATE ______________ CASH VALUE _______________ DATE _____________OWNER OF POLICY ________________________________DATE ISSUED ______________COMPANY ________________________________ AGENTS NAME ______________________ADDRESS _________________________________ PHONE # ____________________________BENEFICIARY ___________________________________________________________________LOCATION OF POLICY ___________________________________________________________DETAILS _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ INSURED ________________________________________ AMOUNT_______________________POLICY # __________________________ PREMIUM AMOUNT __________________________DUE DATE _________________ BANK DRAFT ________ CHECK _______ OTHER ________MATURITY DATE ______________ CASH VALUE _______________ DATE _______________OWNER OF POLICY _______________________________DATE ISSUED __________________COMPANY ______________________________________ AGENTS NAME ___________________ADDRESS _______________________________________ PHONE # _________________________BENEFICIARY _____________________________________________________________________LOCATION OF POLICY _____________________________________________________________DETAILS _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ INSURED _________________________________________ AMOUNT_____________________POLICY # ______________________________ PREMIUM AMOUNT _____________________DUE DATE ___________________ BANK DRAFT ________ CHECK _______ OTHER ______MATURITY DATE ______________ CASH VALUE ______________ DATE ________________OWNER OF POLICY ________________________________DATE ISSUED _________________COMPANY __________________________________ AGENTS NAME _______________________ADDRESS __________________________________ PHONE # ______________________________BENEFICIARY _____________________________________________________________________LOCATION OF POLICY _____________________________________________________________DETAILS ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ INSURED _________________________________________ AMOUNT________________________POLICY # _____________________________ PREMIUM AMOUNT _________________________DUE DATE _________________ BANK DRAFT ________ CHECK ________ OTHER _________MATURITY DATE _____________ CASH VALUE ________________ DATE _________________OWNER OF POLICY ___________________________________DATE ISSUED ________________COMPANY _________________________________ AGENTS NAME _________________________ADDRESS __________________________________ PHONE # _______________________________BENEFICIARY ______________________________________________________________________LOCATION OF POLICY ______________________________________________________________DETAILS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HEALTH AND MAJOR MEDICALINDIVIDUALS COVERED BY POLICY ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________COMPANY ____________________________________________ AGENTS NAME____________________________________ADDRESS _____________________________________________PHONE # __________________________________________POLICY #______________________________________________DEDUCTIBLE _____________________________________PREMIUM AMT. _______________________________________ DUE DATE _______________________________________BANK DRAFT _____________ CHECK ________________ OTHER ___________________________________LOCATION OF POLICY ____________________________________________________________________________________DETAILS OF COVERAGE __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________INDIVIDUALS COVERED BY POLICY ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________COMPANY _______________________________________ AGENTS NAME_________________________________________ADDRESS ______________________________________________PHONE # _________________________________________POLICY #______________________________________________DEDUCTIBLE _____________________________________PREMIUM AMT. _______________________________________ DUE DATE _______________________________________BANK DRAFT ______________ CHECK _________________ OTHER _________________________________LOCATION OF POLICY ____________________________________________________________________________________DETAILS OF COVERAGE _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________DISABILITY INSURANCEINSURED ________________________________________________________________________________________________AMOUNT ________________________________ DUE DATE ________________________________________BANK DRAFT _____________CHECK___________OTHER _________________________________ELIMINATION PERIOD ILLNESS ______________________ ACCIDENT_______________________________COMPANY ________________________________________________ AGENT __________________________________ADDRESS _________________________________________________PHONE # _________________________________LOCATION OF POLICY ____________________________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ INSURED _________________________________________________________________________________________________AMOUNT ___________________________________DUE DATE ______________________________________BANK DRAFT _____________CHECK____________OTHER _______________ELIMINATION PERIOD ILLNESS _________________________ ACCIDENT__________________________________COMPANY _______________________________________ AGENT ____________________________________ADDRESS ________________________________________ PHONE # __________________________________LOCATION OF POLICY ____________________________________________________________________________________DETAILS OF COVERAGE ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PROPERTY INSURANCEPROPERTY ___________________________________________________________________________________________AMOUNT OF COVERAGE ___________________________ DEDUCTIBLE ___________________________________COMPANY __________________________________________AGENT __________________________________________ADDRESS___________________________________________PHONE # ________________________________________POLICY # ___________________________________________PREMIUM AMOUNT _____________________________DUE DATES ______________________________ CHECK ______________ OTHER ______________________ LOCATION OF POLICY ________________________________________________________________________________DETAILS OF COVERAGE ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PROPERTY _______________________________________________________________________________________________AMOUNT OF COVERAGE _____________________________ DEDUCTIBLE _____________________________________COMPANY ___________________________________________ AGENT ___________________________________________ADDRESS____________________________________________ PHONE # _________________________________________POLICY # ______________________________________PREMIUM AMOUNT ______________________________________DUE DATES ______________________________ CHECK _________________ OTHER _________________________ LOCATION________________________________________________________________________________________________DETAILS OF COVERAGE ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________VEHICLE INSURANCEFAMILY LICENSED DRIVERS NAME _______________________________________STATE/LICENSE # _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ ________________________VEHICLE ___________________________________________________________________________________TYPE OF COVERAGE ____________________________________________ DEDUCTIBLE_____________COMPANY ___________________________________________ AGENT ______________________________ADDRESS ____________________________________________ PHONE # ____________________________POLICY # ________________________________________PREMIUM AMOUNT ______________________DUE DATE _____________________________ BANK DRAFT ______ CHECK _______ OTHER ________LOCATION OF POLICY ______________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________ VEHICLE ___________________________________________________________________________________TYPE OF COVERAGE ____________________________________________ DEDUCTIBLE_____________COMPANY ___________________________________________ AGENT ______________________________ADDRESS ____________________________________________ PHONE # ____________________________POLICY # ________________________________________PREMIUM AMOUNT ______________________DUE DATE _____________________________ BANK DRAFT ______ CHECK _______ OTHER ________LOCATION OF POLICY ______________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________ VEHICLE ___________________________________________________________________________________TYPE OF COVERAGE ____________________________________________ DEDUCTIBLE_____________COMPANY ___________________________________________ AGENT ______________________________ADDRESS ____________________________________________ PHONE # ____________________________POLICY # ________________________________________PREMIUM AMOUNT ______________________DUE DATE _____________________________ BANK DRAFT ______ CHECK _______ OTHER ________LOCATION OF POLICY ______________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________ VEHICLE ___________________________________________________________________________________TYPE OF COVERAGE ____________________________________________ DEDUCTIBLE_____________COMPANY ___________________________________________ AGENT ______________________________ADDRESS ____________________________________________ PHONE # ____________________________POLICY # ________________________________________PREMIUM AMOUNT ______________________DUE DATE _____________________________ BANK DRAFT ______ CHECK _______ OTHER ________LOCATION OF POLICY ______________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________ VEHICLE ___________________________________________________________________________________TYPE OF COVERAGE ____________________________________________ DEDUCTIBLE_____________COMPANY ___________________________________________ AGENT _______ADDRESS ____________________________________________ PHONE # ____________________________POLICY # ________________________________________PREMIUM AMOUNT ______________________DUE DATE _____________________________ BANK DRAFT ______ CHECK _______ OTHER ________LOCATION OF POLICY ______________________________________________________________________DETAILS OF COVERAGE _________________________________________________________________________________________________________________________________________________________________Basic Food Storage ListGRAINS = 400 lbs per adult JUICES /BEVERAGES = 25 LBS_____ Barley _____ Apple juice_____ Cereal _____ Apricot Nectar_____ Corn (meal or Dent) _____ Baby strained juices_____ CousCous _____ Cocoa drink mix (4lb/can)_____ Flour (4 lb/can) _____ Cranberry juice_____ Millet _____ Dried juice mix(6lb/can)_____ Multi grain soup mix(5lb/can) _____ Grapefruit juice_____ Oats, rolled quick(3lb/can) _____ Grape juice_____ Oats, rolled regular (3lb/can) _____ Kool-aid_____ Popcorn _____ Lemonade_____ Rye _____ Orange juice_____ Sprouting Seeds _____ Pineapple juice_____ Wheat (6lb/can) _____ Plum juice_____White Rice (6lb/can) _____ Prune juice _____ Punch crystalsPASTAS _____ Soft drink mixes_____ Macaroni (3lb/can) _____ Soft drinks_____ Noodles _____ Tomato juice_____ Spaghetti (4lb/can) _____ V-8 juice MILK / DAIRY = 75 per adultFATS / OILS = 20 lbs per adult_____ Brick cheese_____ Butter_____ Canned milk_____ Cooking oil_____ Canned sour cream_____ Lard_____ Cheese spreads_____ Margarine_____ Cheese spreads_____ Mayonnaise_____ Condensed milk_____ Olive oil (extra virgin)_____ Dried cheese_____ Peanut butter_____ Infant formula_____ Powdered butter_____ Non-dairy creamer_____ Powdered margarineMILK / DAIRY = 75 lbs per adultFATS/ OILS = 20 lbs per adult (cont.)_____ Non-fat dry milk (4lb/can)_____ Powdered shortening_____ Powdered cheese_____ Salad Dressing_____ Powdered sour cream_____ ShorteningCANNED OR DRIED MEATSAUXILIARY FOODS(20 lbs per adult)_____ Baking powder_____ Bacon_____ Baking soda_____ Beef_____ Cake mixes_____ Beef jerky_____ Calcium supplement_____ Chicken_____ Casserole mixes_____ Clams_____ Chow Mein noodles_____ Corned beef_____ Cookies_____ Crabmeat_____ Cookie mixes_____ Deviled meats_____ Cornstarch_____ Fish_____ Crackers_____ Ham_____ Cream of tarter_____ Hamburger_____ Hot roll mixes_____ Lamb_____ Hydrated lime (for tortillas)_____ Lunch meats_____ Instant breakfast_____ Mutton _____ Instant yeast_____ Pepperoni_____ Iron supplement_____ Pork_____ Marshmallows_____ Tuna_____ MRE’S_____ Salmon_____ Muffin mixes_____ Sandwich spreads_____ Non perishable pet foods_____ Sardines_____ Pancake mixes_____ Sausage_____ Pastry mixes_____ Shrimp_____ Pectin_____ Spam_____ Pie crust mixes_____ Turkey`_____ Pie fillings_____TVP – textured veggi protein_____ Pizza mixes_____Veal_____ Plain gelatin_____Venison jerky_____ Rennin tablets_____Vienna sausage_____ SaltAuxiliary Foods (contl)_____ Vitamins and minerals_____ Sourdough starter _____ Whipped topping mixes_____ Survival bars_____ Tofu solidifierFRUITS AND VEGETABLES90 lbs Dried, 370 qts canned, 370 lbs FruitsVegetables______Apples (2lb can)_____Artichoke hearts______Applesauce_____Asparagus_____Apricots_____Beans_____Peaches_____Beets_____Berries_____Broccoli_____Cherries_____Brussels sprouts_____Coconut_____Carrots_____Currants_____Cauliflower_____Figs_____Celery_____Fruit cocktail_____Corn-sweet_____Grapefruit_____Green beans_____Grapes_____Hominy_____Mandarin oranges_____Mushrooms_____Nectarines_____Okra_____Olives_____Onions (2lb/can)_____Pears_____Parsnips_____Peaches_____Peas_____Pineapple_____Peppers_____Plums_____Pickles_____Prunes_____Potatoes, flakes (1.5lb/can)_____Rhubarb_____Potatoes, pearls(3lb/can)_____Raisins_____PumpkinsVegetables (cont.)_____Rutabagas_____Sweet potatoes (yams)_____Salsify_____Tomatoes_____Sauerkraut_____Tomato powder_____Soups_____Turnips_____Spinach_____Water chestnuts_____SquashBEANS & LEGUMES(90lbs per adult)_____Beans, pinto (5lb/can) _____Nuts_____Beans, pink (5lb/can) _____Peas_____Beans, white (5lb/can) _____Sprouting beans and seeds_____Lentils _____SoybeansSPICES / CONDIMENTS_____ Almond extract_____ Oregano_____ Allspice_____ Paprika_____ Baking Chocolate_____ Pepper_____ Basil_____ Poultry Seasoning_____ BBQ sauce_____ Protein supplement_____ Bouillon cubes / granules_____ SageBeef, Chicken, Onion, Vegetable flavors_____ Salad Dressings_____ Cayenne Pepper_____ Salt (5 lbs per adult)_____ Celery Salt_____ Sauce mixes_____ Chili Powder_____ Seasoned Salt_____ Chives_____ Spaghetti Sauce_____ Chocolate Chips _____ Soy Sauce_____ Chocolate Powder_____ Steak Sauce_____ Chocolate syrup_____ Tarragon_____ Cinnamon_____ Thyme_____ Cloves_____ TurmericSpice’s and condiments (cont.) Sugars = 60 lbs per adult_____ Cocoa_____ Corn Syrup_____ Coriander_____ Hard candy_____ Cumin_____ Honey_____ Curry_____ Jello_____ Dill Weed_____Jelly or Jam_____ Garlic Salt_____Maple syrup_____ Ginger_____Molasses_____ Gravy mixes_____Pudding, Chocolate, Vanilla_____ Herbs(5lb /can each)_____ Ketchup_____Sugar (6lb / can)_____Lemon Extract_____Liquid Smoke _____Marjoram_____Maple Extract _____Nutmeg_____Onion Flakes_____Onion Salt_____Orange peel_____ Vanilla extract_____ Vinegar (white / apple cider)_____ Worcestershire SauceThree Month’s Supply of Comfort FoodThis list is to help you obtain a three month’s supply of comfort food. Comfort food is the food your family eats on a daily bases. This is a general list and you can add different foods depending on what your family will eat. Some items on this list are fresh and will obviously need to be rotated and used quickly.Canned Fruits PastaDrinksFrozen FoodsPeachesSpaghettiChocolate PowderOrange JuicePearsLasagnaDrink mixApple JuicePineappleElbow roni PostumGrape Juice CrushedAcini De Pepe (frog eye)Apple JuiceMixed Fruit Juice ChunkedShellroniApricot NectorHash Browns RingsEgg NoodlesCranapplePeas TidbitsMac & CheeseOld Orchard JuicesBroccoliApricotsCurley NoodlesCauliflowerFruit CocktailRiceMeats - FrozenCarrotsMandarin OrangesMixed VegetablesRed BeansBeef-RoastIce CreamWhite Beans SteaksFrozen FruitPinto Beans Stew MeatCanned Vegetables HamburgerCanned Goods Stables ground Tomato – Sauce patties Soups - PasteFlourChicken-whole Tomato WholeSugar pieces Cream of ChickenSpaghetti SauceSalt breast Cream of Mush. CornHot Cereal Pork - chops VegetableBeetsCold Cereal roast NoodleHominy Corn Meal ham hocksDry SoupPork and BeansJello bacon Tuna Kidney Beans ham Chunked -TurkeyGreen Beans Nuts sausage ChickenCanned PotatoesCanadian Bacon HamCarrotsFish Sticks Clams / ShrimpSpinachHot Dogs ManwichInternational Spice’s Spice’s (cont.) Chinese- NoodlesBaking SodaGarlic Cloves ChowmeinBaking PowderGarlic Salt Water ChestnutsPepperBacon Bits Sweet & SourSaltMarshmallows Fortune CookiesYeastBouillon cubesMexican – Taco Shell’sChoc. Chips Chicken EnchiladasCoconut Beef BurritosLemon Juice Pork SalsaChili Powder Refried BeansNutmegItalian- PizzaCinnamonMonthly Food Storage Purchasing Calendarcompiled by Andrea ChapmanIf you are just starting out, this calendar can be used any year.Just start with the current month’s items.Be certain to buy only items your family will use, and rotate and use the items in your storage throughout the year. * The items in the first few months are basic essentials and are the most important to purchase and store. It is vital to get WATER – STORAGE . If you don’t have water, you will not be able to use many of the foods you have that are dehydrated or require water to cook. Many times in natural disasters, the electricity goes down and you will not be able to access your water. Sometimes the water is contaminated from flooding and cross – contamination from sewage. You will need water, at very least, you will need 4 days worth.______________________________________________________________________________ JANUARYWeek # 1 1 case canned fruitWeek # 22 #2 cans instant potatoes Week # 33 # 10 cans dried milkWeek # 49 pounds yeastWeek # 5anything you have missed from above______________________________________________________________________________FEBRUARYWeek # 1Water Storage Containers; buy either 55 gallon drums, 5 gallon water containers (available at all emergency prepared-ness stores and some super markets) and spigot, or start to save water in pop bottles and plastic juice containers. Also purchase 100 pounds hard white wheat and three plastic storage buckets with tight fitting lids. Check out the local mills in your area for best prices. Week # 225 lbs sugar or 20 lbs of honey5 lbs salt per personbucket openerWeek #34 # 10 cans shortening or 4 – 48 oz. bottles oil2 # 10 cans of dry instant milkWeek # 42 case canned beans (like refried pint, black, kidney, white, pink, etc.) or 25 lbs dry beans (preferable) and bucket to storethem in.50 lbs dried corn or popcorn and a bucket to store it in.(can be ground into cornmeal as well as for popcorn)______________________________________________________________________________March(many of these items will be repeats because it will build up your essentials)Week # 1Enough water containers for 14 gallons per person in the family. (This was mentioned last month because water is veryimportant to have Water is your most important item!)If you didn’t get enough containers last month you can get themthis monthWhite Rice, at least 15lbs per person in the family and if possible buckets to store it. (brown rice goes rancid faster.)Week # 22 jars mayonnaise2 gallon oil2 # 10 cans shorteningWeek # 325 lbs sugar1 25 lb bag of legumes (beans: white, pinto, pink, lentils etc.)Week # 4Salt 5 more lbs2 gallons bleach1 # 10 can or 1 box of dry milkWeek # 5Check your list for the last 8 weeks and purchase any items you fell short on. These items are essential ones and you will need to be sure you have enough.______________________________________________________________________________APRILWeek # 1100 lbs wheat10 lbs brown sugarWeek # 22 # 10 cans dried fruit or 1 case canned fruit1 lb yeastWeek # 31 case tuna or salmon2 # 10 cans milk3 lbs sprouting seeds1 80 oz can Rumsford baking powderWeek # 42 large jars peanut butter or1 # 10 can peanut butter powder (lasts longer)2 cans dried whole egg (keep in a cool dry place)MAYWeek # 1 2 to 3 bottles of multi-vitamins2 # 10 cans of rolled oats(if # 10 cans are not available in your area, buy the largest packages available in your local store, and also purchase a small bucket to store it in.)Week # 2100 lbs of wheat 3 bucketsWeek # 31 # 10 can margarine powder – or shortening if marg.powder is unavailable2 # 10 cans rolled oats(or equivalent and a storage bucket)Week # 44 # 10 cans instant potatoes1 bottle black pepper______________________________________________________________________________JUNE Week # 12 cans dry milk, 2 boxes of Rennet(used for making cottage cheese and other dairy products from from dry milk.)1 bottle lemon juice1 bottle vinegar, (also used in making dairy products from dry milk)Week # 2100 lbs wheat25 lbs flourWeek # 3Baking soda (try to buy in bulk in places like Sam’s Club or Cosco.) Buy about 10 lbs.25 lbs Legumes (choose those you are willing to eat.Remember you can sprout legumes and almost quadruple the nutritional value of them. Buy one large box Knox or other gelatin to be used in place of eggs in bakingWeek # 4 Buy 3 cases Tomato products (try to buy them by the case in normal size cans. Spaghetti sauce, tomato sauce, whole and chopped tomatoes.Week # 5Be on the look out for Garden seeds that are NON-HYBRID.That way you can use the seeds from the plants you grow to grow a garden the next season. JULYWeek # 1200 lbs wheat(buckets to store it in)keep filling bottles with water (pop bottles, juice bottles, syrup bottles etc…basically no cost to do this)Week # 220 lbs peanut butter(keep filling those water containers)Week # 34 # 10 cans dry milk2 # 10 cans dry milk(keep filling water containers – make this a habit – when you empty something worthy of water storage, wash it and fill it right away.)Week # 46 # 10 cans dry milk(more water!)______________________________________________________________________________AUGUSTWeek # 125 lbs rice 25 lbs sugar1 # 10 can instant potatoes5 lbs saltWeek # 21 case tuna or salmon or other meat2 # 10 cans dry milkWeek # 32 # 10 cans dry milk2 # 10 cans shortening1 # 10 can instant potatoesWeek # 42 cases fruit5 lbs saltNote* In late August early September, many stores have sales on canned fruits and vegetables. Ask your local store when these sales will be, and switch the weeks of this calendar as needed.Week # 52 cases canned fruit1 case misc. vegetables (green beans, peas, carrots, etc)SeptemberWeek # 12 cases canned fruit1 case misc. vegetablesWeek # 22 cases canned fruit2 # 10 cans shorteningWeek # 32 cases fruit1 case vegetablesWeek # 42 cans shortening25 lbs rice(buckets to store it in- if necessary)______________________________________________________________________________OctoberWeek # 1100 lbs wheat and 3 bucketsWeek # 21 case tuna or other meatWeek # 325 lbs sugar2 large cans fruit juice powderWeek # 43 # 10 cans dry milkWeek # 5 9 # 10 cans potato flakes______________________________________________________________________________NovemberWeek # 1 4 large jars peanut butterWeek # 21 case canned fruit15 lbs riceWeek # 37 # 10 cans shorteningWeek # 450 lbs rice and buckets to store it in______________________________________________________________________________DecemberWeek # 1100 lbs wheat and 3 bucketsWeek # 21 large can fruit juice powder3 large jars peanut butterWeek # 33 # 10 cans dry milkWeek # 450 lbs of rice, oats, or barleybuckets to store it in.96 HOUR SURVIVAL KITINDIVIDUAL KITbackpack, duffle bag, rolling suitcase or tote, etc...) to hold the following items:COMMUNICATIONRadio, extra batteries, whistle, walkie-talkie, clock.FIRST AID First Aid Kit, medications, medical history.CONTAINERWaterproof container (such as name tags with name, address, blood type, allergies, school, sewing kit, insect repellent.SHELTERTent or tarp, rope ?” X 36 feet.BEDDINGSleeping bag, Mylar blanket, wool blanket, tarp, ground cover.FOODLight weight food requiring little or no cooking or refrigeration, evaporated milk, powdered milk, cereal, grainola bars, juice crystals, jerky, canned meat (Vienna sausage, canned tuna, canned chicken or turkey, dried beef) dried fruit, dried soups, ramen noodles, peanut butter, crackers, nuts, salt and pepper, sugar, MREs, freeze dried food, food in foil pouches. COOKING Utensils for cooking, single burner stove, can opener, tin cup, paper towel, plastic wear, cups, plates.FUELPropane cylinders for cooking, light, and heatingWATER1 gallon water per person per day for 4 days, water purification tablets, or 8 drops of chlorine bleach per 1 gallon of water.LIGHTSFlashlight, extra batteries, candles with holder, waterproof matches, lighter.SANITATION1 air tight bucket or porta-pottie, toilet paper, newspaper, disinfectant, trash bags, dish soap, chlorine bleach, 12 large garbage bags, rubber gloves.CLOTHING Coat, change of clothes, extra shoes and socks, gloves, raingear, adequate winter wear, stocking cap, ski- bibs, insulated coveralls heavy work gloves, include baby items.PERSONAL ITEMSTowel, wash cloth, toothbrush, toothpaste, brush, comb, mirror, shampoo, soap, hand lotion, feminine hygiene, baby items: diapers, diaper cream, petroleum jelly, etc…TOOLS Pocket knife(Swiss Army type) small tools, hatchet, pointed shovel, scissors, vice grip pliers, duct tape, fish hook and line.IMPORTANT PAPERS Will, testaments, stocks, securities, titles, certificates, insurance, currant family pictures, I.D. cards and tags, inventory of household items, pencil and paper, maps, phone numbers, emergency handbook, car keys, house keys, accounting information, survival book.MONEYCash and changeFUN THINGSbooks, small toys, card games, small travel games, coloring crayons, coloring books, paper and pencil, remember special occasions ie; birthdays, anniversaries etc…FAMILY SURVIVAL KITCONTAINER1 waterproof container (32 Gallon garbage can, rolling tote, rolling suitcase etc…)to hold the following items:COMMUNICATIONradio with extra batteries, walkie-talkies, clock, whistle.FIRST AIDfirst Aid kit, medication, insect repellent, sewing kit, safety pins, heavy duty sanitary pad, hand lotion, aspirin, ibuprofen.SHELTERtent, tarp, ground cover, tent pegs, hammer.BEDDINGemergency Mylar blanket, wool blanket, sleeping bag.FOOD MRE’s, jerky, fruit leather, other dry prepared food, juts, canned tuna, canned chicken, canned turkey, dried beef, plates, cups, plastic wear, Stress food such as hard candy, gum, etc… Baby food and pet food. COOKINGcooking utensils, pan with lid, single burner stove, tin cup, matches, lighter, can opener.FUELpropane cylinders for heat, light and cooking, wood, briquettes.WATER1 gallon water per person per day for 4 days, water purification tablets or 8 drops of chlorine bleach per 1 gallon of water.LIGHTflashlight, extra batteries, lantern with extra propane cylinder, mantle, candle with holder.SANITATIONcleaning supplies, toilet, toilet paper, 12 large plastic garbage bags, chlorine bleach, bucket, newspaper, rubber gloves.CLOTHINGchange of clothes for each member of the family, warm clothes for winter and cool clothes for summer, body warmer, extra shoes and laces.TOOLSpocket knife (Swiss Army type), ax, shovel, fish hook and line, fire extinguisher, rope ?” x 36 feet, (depending on your family size you may want to double or triple this amount), duct tape, string, scissors, twine.IMPORTANT PAPERSFamily Emergency Handbook which should contain: wills, testaments, current family pictures, I.D. cards and tags, inventory of household items, pencil and paper, maps, phone numbers, extra car and house keys, accounting information, and survival manual.MONEY cash and change.FUN THINGS books, small toys, and games, small traveling games, coloring books, coloring crayons, paper and pencils. Remember little gifts for special occasions, birthdays, anniversaries, etc….96 Hour Kit Supply ListFOOD ITEM# Per Kit# of KitsTotal # NeededTang (1/4 cup each serving)3 servingsInstant Oatmeal3 servingsCocoa Mix (1/4 each serving)3 servingsSingle Serving Stew or Pasta w/pop top lid2 servingsSingle Serve Beanie Weenies w/pop top lid2 servingsGranola Bars3Single Serving Tuna & Crackers2Single Serve Lipton Noodle Soup3 envelopes1 oz. Beef Jerky3 packages.5 oz. Fruit Roll-ups31 oz. Raisins2 packagesGum12 sticksJolly Ranchers12 piecesPlastic Spoons4Matches1 mini boxSnack-size Zip-lock Bags for Tang and Cocoa6 baggiesClear Packaging Tape to Close Jug1Stove1Fuel Pellets or Small Can Sterno4 packagesTowelettes10These items will all fit in a 1 gallon milk jug. You will need to add a 1st aid kit and equivalent to 1 gallon of water Per day (4 gallon). FIRST AID KITThese are suggested items to build your own.____Adhesive tape 1 roll 10 yards ____First-aid Manual ____Activated charcoal (on advice of Poison Control Ctr) _____Gauze 1 roll 2” x 2 “ x 10 yards____Alcohol swaps ____Gauze 8) 2” x 2” pads____Aspirin / Tylenol ____Gauze 8) 2” x 3” pads____Ammonia inhalant ____Gauze 8) 2” x 4” pads____Antacid tablets ____Heat tablets____Antibacterial ointment ____Hot pack____Antibacterial soap ____Hot water bottle____Anti-diarrhea ____Hydrogen peroxide____Antiseptic ____Ice bag or cold pack____Antihistamine ____Iodine____Arm sling ____Laxative____Bandages ____Lip Balm____ 1) 3” wide ace ____Lotion____ Triangular 40” square ____Matches____ Band-aids 20 (assorted sizes) ____Medication(s)____ Butterfly bandages ____Needles____Blanket ____Safety pins (12 assorted)____Compress 2” wide ____Scissors____Consecrated oil (for anointing) ____Splints (popsicle & larger)____Cotton Balls ____Sunscreen____Cotton swaps ____Super glue____Disinfectant ____Syrup of Ipecac ____Disposable gloves ____Table salt____electrolyte drink (Pedialyte) ____Thermometer____Eye drops ____Tongue Blades____Face Cloths (2) ____Tweezers____Cold medicine ____Vaseline____Cough drops ____Zinc Oxide(diaper rash)FAMILY EMERGENCY QUICK GUIDEStabilize family members, 1st Aid/CPRReport home condition using colored flag(s)Turn off all utility valves (only if necessary)Contact family members who are not at homeIf you need to evacuate take your 96 hour kit and leave immediately (secure your home) let your contact know where you are goingIf you need to shelter in place, prepare to be self reliant and live off your 3 month supplyWhen family is stable go out and help in your area and/or report to the Damage Control Center (located at the pre-determined location) for further instructions ................
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