LIFE PLAN - Greenville Community Christian



centercenterSeptember, 2019Community Christian Church – Bible StudyLIFE PLANPersonal information8820090900September, 2019Community Christian Church – Bible StudyLIFE PLANPersonal informationPersonal InformationLegal Name: _________________________________________________________________Also Known As (AKA) ___________________________________________________________Maiden Name _________________________________________________________________Address ________________________________ PO Box _______________________________City __________________________________________State _____________ Zip _________ Phone Numbers: Home _________________ Mobile ______________ Work ___________Last Four of Social Security Number _________________ (Optional)Location of Social Security Card _______________________________________________________Birthday _______________________________________Birth Place ______________________________________Marital Status ___________________________________Date Married ____________________________________ Place _____________________________Spouse’s Name _____________________________________________________________________Former Spouse Name _______________________________________________________________ Father’s Name _____________________________________________________________________Father’s Birthplace _________________ Father’s Birthday _________________________________ Mother’s Name ____________________________ Maiden Name _______________________________ Mother’s Birthplace _________________ Mother’s Birthday _________________________________ Siblings’ Names: 1. _______________________________ Spouse _______________________2. _______________________________ Spouse ________________________3. _______________________________ Spouse _______________________4. _______________________________ Spouse ________________________5. _______________________________ Spouse _______________________Children’s Names: _______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work _______________________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work _______________________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work _______________________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work _______________________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work _______________________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Worship:Church _________________________________________________________________Phone: ___________________________ Email ________________________________Location _______________________________________________________________Pastor _________________________________________________________________Other (e.g.) Care leader, Small Group Leader) _________________________________Phone: ___________________________ Email ________________________________Work:Company, Organization or Business Name _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Occupation: _____________________________________________________________Resume is Located ________________________________________________________Citizenship Information____________________________________________________Military Service Yes___ No ____ if yes; Branch ________________________________Date of EntryDate of Discharge ______________________ Rank at Time of Discharge _____________Duty StationsMOS, AOC or WOMOS ___________________________Rank if Still Active Duty ____________DD214 is located ________________________________________________________________Notes: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Medical Information:In Case of Emergency Notify: __________________________________ Relationship ________Address ________________________________________________________________________City ___________________________________State ________________ Zip ________________ Phone Numbers: Mobile _____________ Home ______________ Work ___________ _________Blood Type ________________ Medical Conditions _____________________________________Medications 1. ___________________ Dosage ____________ Times Per Day _____________ 2.___________________ Dosage ____________ Times Per Day _____________ 3.___________________ Dosage ____________ Times Per Day _____________ 4.___________________ Dosage ____________ Times Per Day _____________Allergies and Reactions_______________________________________________________________Primary Physician: ______________________________________________________________Doctor’s Office ____________________________ _____________________________________Address ________________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Specialist: ______________________________________________________________Doctor’s Office ____________________________ _____________________________________Address ________________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________My Living Will is Located _____________________________________________________________My Health Care Power of Attorney is Located ____________________________________________My Health Agents Are: Primary ______________________; 2 ________________________________Health Information: ___________________________________________________________________________________________________________________________________________________Special Health Situations _________________________________________________________________________________________________________________________________________________Pharmacy _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________SSA/ Medicare Acct _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Professional ServicesMinister _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Attorney _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Accountant _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Tax Preparer _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Financial Advisor _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Insurance Agent _____________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Mortgage Lender or Landlord _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Other __________________________________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Financial Information:Bank AccountsType of Account ______ Checking; ________ Savings; _______Investment Bank ___________________Account Number ______________________________Online Line User Name _________________ Pass Word ______________________Type of Account ______ Checking; ________ Savings; _______Investment Bank ___________________Account Number ______________________________Online Line User Name _________________ Pass Word ______________________Type of Account ______ Checking; ________ Savings; _______Investment Bank ___________________Account Number ______________________________Online Line User Name _________________ Password ______________________AMT Card ______ Checking; ________ Savings; _______Investment Bank ___________________Account Number ______________________ PinOnline Line User Name _________________ Pass Word ______________________AMT Card ______ Checking; ________ Savings; _______Investment Bank ___________________Account Number ______________________Pin _____Online Line User Name _________________ Pass Word ______________________Type of Account: Credit Card Bank ___________________Account Number ______________________ Pin _____Online Line User Name _________________ Pass Word ______________________Type of Account: Credit Card Bank ___________________Account Number ______________________Pin _____Online Line User Name _________________ Pass Word ______________________Type of Account: Credit Card Bank ___________________Account Number ______________________Pin ______Online Line User Name _________________ Pass Word _______________________Investments and Retirement Accounts:Investment _________________________________________Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Online Line User Name _________________ Pass Word/PIN______________________IRA _______________________________________________ Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Online Line User Name _________________ Pass Word/PIN______________________Long Term Saving ____________________________________ Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Online Line User Name _________________ Pass Word/PIN______________________401K or 403B_________________________________________ Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Online Line User Name _________________ Pass Word/PIN______________________Other Investment Account _____________________________ Account # ___________ Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Online Line User Name _________________ Pass Word/PIN______________________Other Accounts: Rewards, Frequent Flyers, etc.Home Owners Association _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Frequent Flyers _________________________________________Account # _______Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Safe Deposit Box _______________________ Bank_____________ Box # __________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Online Health Records _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________IRS Online Account __________________________________Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________DMV Online ________________________________________Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________What I OweMortgage _________________________________________Account # _____________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Auto Loan _________________________________________Account # ___________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Home Equity _________________________________________Account # _______Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Student Loan _________________________________________Account # _______Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Credit Card _________________________________________Account # _______Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Other _________________________________________Account # _______Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________What is Owed to MeOwed By _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Owed By _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Loaned to _______________________________________________What was loaned? ________________________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Insurance Policies:Type of Policy _________________________________________________________Account Number ________________________________________________________Amount _______________________________________________________________Beneficiary(ies) _________________________________________________________Contact Information ___________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Type of Policy _________________________________________________________Account Number ________________________________________________________Amount _______________________________________________________________Beneficiary(ies) _________________________________________________________Contact Information ___________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Employer BenefitsAccount Number ________________________________________________________Amount _______________________________________________________________Beneficiary(ies) _________________________________________________________Contact Information ___________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________Social SecurityAccount Number ________________________________________________________Amount _______________________________________________________________Beneficiary(ies) _________________________________________________________Contact Information ___________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________What I Own- AssetsPrimary Home Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________Online Line User Name _________________ Pass Word/PIN______________________ Home Owners Association _______________________________________________Auto Mobiles, Vehicles, BoatsMake __________ Model_________Year ___________ Vin # ____________Make __________ Model_________Year ___________ Vin # ____________Make __________ Model_________Year ___________ Vin # ____________Make __________ Model_________Year ___________ Vin # ____________Make __________ Model_________Year ___________ Vin # ____________Make __________ Model_________Year ___________ Vin # ____________ Real Estate _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Phone Numbers: Office _____________ Direct ______________ Emergency _________ Real Estate _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Equipment _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Other _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Other _______________________________________________Address _________________________________________________________________City ___________________________________State ________ Zip ________________ Auto Payments OnlineAccount Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Account Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Account Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Account Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Account Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Account Name __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Subscriptions:Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________Publication __________________________________ Account # ________________Online Line User Name _________________ Pass Word/PIN______________________Details _________________________________________________________________Notes __________________________________________________________________MembershipsOrganization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Organization __________________________________ Member # ________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person ________________________________ Phone ____________________Notes __________________________________________________________________Social Media/EmailEmail __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Email __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Facebook __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Twitter __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes _________________________________________________________________ Other __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Other __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Other __________________________________ Member # ______________________Online Line User Name _________________ Pass Word/PIN______________________Notes __________________________________________________________________Website __________________________________ Domain Host _________________Online Line User Name _________________ Pass Word/PIN______________________Contact Person __________________________________________________________WillMy Will is Located: ___________________________________________________________Executor of My Wil is: __________________________________________________________Secondary Executor of My Will is: _________________________________________________Back of Copies of My Will are Located: ____________________________________________My DNR /Do Not Resuscitate Order is located (if applicable) ___________________________My Organ Donor Information is Located ____________________________________________In the Event of My Death Please Contact the FollowingImmediate Family Member1. Spouse: Page 12. Children: Page 23. Parents Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Family MemberName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________FriendName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________FriendName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________EmployerName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Co-WorkerName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________ClassmateName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Veteran AffairsOtherName_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________Name_______________________________ Spouse _________________________Address ___________________________________________________________City ___________________________________State ________ Zip ___________ Phone Numbers: Home _____________ Mobile ______________ Work ________My Final ArrangementsContact PersonFinancial Arrangements: ________Insurance, _______ Pre-need, ______Savings ______ OtherPreferred Disposal of My Remains BurialCremationDonate Body to Medical Research Service: _____Funeral; _____Graveside; _____Memorial Service; _______None Other Information: ................
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