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I HAVE PUT MY HOUSE IN ORDER Personal Records of:
CONFID EN T I A L
KEEP IN A SECURE LOCATION PREVENT UNAUTHORIZED DISCLOSURE
You Know the Firm. Experience the Difference. 501 WEST COLFAX STREET PALATINE, ILLINOIS 60067 847-705-7555 www.lavellelaw.com
THIS BOOKLET CONTAINS HIGHLY SENSITIVE, CONFIDENTIAL INFORMATION. KEEP IT IN A SECURE LOCATION. DISCLOSE ONLY TO TRUSTED FIDUCIARIES.
“I HAVE PUT MY HOUSE IN ORDER” is a unique booklet that avoids the needless and costly loss of time and money incurred in times of emergency. It will save hours of anxiety and grief for your family and possibly thousands of dollars. Fill out this booklet today! In case of sickness, disability, away from home, or in the event of death, this concise, but thorough, digest of “Where to Look,” “Whom to See,” and “What I Own” will tell where all the records are without disclosing any figures as to your worth. After you have properly completed this booklet, give it to the person you have selected to handle or administer your financial affairs in an emergency. If you do not wish to give it to someone, since you might periodically make changes, be sure that person is aware of its current location. Whenever you make any revisions or update this book, be sure to indicate the date in the proper space provided. This record book was completed on the
Day of
20
by
REMEMBER
If you die and leave no will, the laws of the state in which you reside will dictate how your property is distributed. No matter how small or large your estate may be, not leaving a will may cause significant inconvenience for your survivors. A will gives you the advantage of specifying: • Who should receive your property • When it should be distributed • The amounts of distribution • How it should be safeguarded • By whom it should be handled • Who shall raise your minor children We advise you to consult with Lavelle Law and be sure you have a properly drafted will. If you already have a will, it is important that it is periodically reviewed to make certain it is consistent with your current wishes. LAVELLE LAW, LTD.
501 WEST COLFAX STREET PALATINE, ILLINOIS 60067
847-705-7555
www.lavellelaw.com
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
My legal residence is located at: City State County
MY WILL
I have no will.
Original executed copy of my will is located at: It is dated:
,
The original executed Codicil (revision) is located at:
It is dated:
,
Attorney who drafted my will is: Name Phone
Named as Executor(s) and Trustee(s): Phone Phone
Named as Guardians of my Children:
Witnesses to will: (List Names and Addresses)
Will is located at: I have executed Durable Powers of Attorney. They are located at: The attorney who drafted these documents is:
I have no Durable Powers of Attorney. CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
MY TRUST I have no trust(s). Establishing a Trust is one of the common ways of providing care to dependents. LIVING TRUSTS are those established during life. TESTAMENTARY TRUSTS are those established by will, but effective after death. I have created a Trust for the benefit of: Established on: , Trustees are: Attorney who drafted the trust agreement: Trust agreement is located at: I am a beneficiary under a Trust established by: Pertinent Papers located at: At my death, my heirs are beneficiaries of Trusts created by: Pertinent records located at:
PERSONAL DATA & RECORDS
These are required for insurance purposes; social security; pensions; and in many other cases where legal proof of age, relationship, or place of birth is required. Date of Birth:
Month
Place of Birth:
City
Day
Year
County
State
Birth Record is located at: Are you a citizen of a foreign country? Yes No Date entered U.S.A.: Citizenship Papers at:
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
Married to:
First
Middle
on:
Month Day Year
Maiden Name
at: Place
City
State
Marriage Records at: Birth Date of Spouse:
Month
Day
Place of Birth:
City
County
Year
State
Country
My Children are: (List Birth Date and Name)
If no children, list brothers and sisters.
Widowed Date:
Month
Day
Year
Cause of Death:
Cause
City
Age
(if divorced or legally separated, fill out below)
I was: divorced on:
legally separated at: City
State
(Spouse or Former Spouse’s Name)
Records at: Attorney:
PARENTS / GUARDIANS
Father: Born:
Date Place
Died:
Date Place
Buried at: Mother: Born:
Date Place
Died:
Date Place
Buried at: CONFIDENTIAL. KEEP IN A SECURE LOCATION.
PREVENT UNAUTHORIZED DISCLOSURE.
MILITARY SERVICE
Check here if no record of military service. Branch of Service: Country:
from:
to:
Date of Discharge: Type of Discharge: Highest Grade or Rank Attained: Military Serial Number: Veteran’s Claim Number: Military Records and Discharge Papers are located at: Service Connected Disabilities: (List %)
Pension and Retirement Benefits Data can be found at:
SAFE DEPOSIT BOXES
All important records, documents, and valuable personal possessions should be given the maximum protection. A loss by fire or theft or misplacement can be costly. The most convenient and best safeguard is to rent a safe deposit box. I have do not have a safe deposit box(es). Located at: Keys will be found at:
The following person has access: (Name & Address)
PERSONAL SAFE
Located: Keys located at: Combination located at: CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
EMPLOYMENT Company Name: Address: Phone: Date Started:
Supervisor:
Social Security No.: Card located at: In addition, I am eligible under the following pension, profit sharing or other benefit plans: 1. 2. 3. 4. I am am not a member of a Labor Union. Name of Local Union: Name
Address
WHAT I OWN
All assets in the following sections are owned solely by me unless otherwise noted.
CHECKING & SAVINGS ACCOUNTS
Checking Accounts: 1.
Bank Name
Account Number
Login ID
Password
Bank Name
Account Number
Login ID
Password
Bank Name
Account Number
Login ID
Password
Bank Name
Account Number
Login ID
Password
2.
Savings Accounts: 1.
2.
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
Joint Accounts with: (Name & Acct. No.)
Name of person who has power to sign checks for me: Name
Address
Phone
REAL ESTATE
I do do not own real estate. I am the sole owner. It is located at: Mortgage on my residence is held by: Real Estate Closing documents are located at:
Other Real Estate I own: I am sole owner. Documents pertaining thereto are located at: Insurance Coverage is handled by: Name of Broker
Address
Phone
Policies are located at: I lease property to others: Yes No Vacant Improved to:
Name
Address
Phone
at:
List Location
Leases can be found at:
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
U.S. SAVINGS BONDS
I do do not own U.S. Savings (Defense) Bonds. I am sole owner. List of Bonds – Serial Numbers – Co-Ownership – and who is a Beneficiary at my death can be found at: Bonds are located at:
SECURITIES – STOCKS & BONDS
Valuable rights are often lost because the owners of stock certificates and bonds cannot be located. All the records of Purchase and Sale, etc., are necessary for tax purposes. I do do not own securities (Stocks & Bonds). List of all securities and certificate numbers will be found at: Certificates located at:
I do
do not
have a brokerage account.
Name of Broker or Firm: Name
Address
Phone
Brokerage Website Login ID
Password
Records of Purchase and Sale are located at: List securities pledged for loans: with Lender Address with Lender Address with Lender Address
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
JOINT OWNERSHIP
I do do not own any Real or Personal property in joint ownership. List interest and designate type: Bank Accounts, Stocks, Bonds, Real Estate, Personal Property, etc. 1. Joint Owner: Address:
2. Joint Owner: Address:
3. Joint Owner: Address:
4. Joint Owner: Address:
LIFE INSURANCE
Insurance policies and premium receipts should be kept in a safe place. I do do not have Life Insurance. Completed itemized list can be found at:
Policies are located at: Policies Covering Others –I own insurance policies on the lives of others. A list of companies and policy numbers are: Policies are located at: CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
Name(s) of persons insured:
I have have not made loans against some of the policies. Source of Loan: Address Phone Pertinent papers are filed with the policies: (Check): Endorsements Dividend Payments Premium Receipts Assignments Settlement Agreements I do do not have annuities: Detailed list is located at: Location of annuity contracts: My principal life insurance broker is: Name: Address Phone
MEDICAL & LONG TERM CARE INSURANCE ADDITIONAL COVERAGE – Accident, Hospitalization, Disability, Long Term Care and all other insurance (in addition to and exclusive of those covered by employer) not noted elsewhere. Location of List: Location of Policies:
I am
Broker/Agent Phone
MEDICARE
am not
Enrollment:
Date
registered for Medicare. at:
City
State
Medicare card located at: Supplement: CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
PERSONAL PROPERTY
I own the following personal property: Auto: Yes No
1. Make Year 2. Make Year Title(s) located at: Record of Inventory located at: Jewelry: Yes No Inventory list & Appraisals located at: Boat:
Yes
No
1. Make Year 2. Make Year Located at: Miscellaneous Personal Property: (not previously listed) Pertinent Insurance policies on personal property are located at: Insurance Broker: Name Phone Proof of Ownership, Receipts, Bills of Sales, etc., are located at: CREDIT CARDS (Attach complete list) I possess the following credit cards: Card type
Login ID
Password
Card type
Login ID
Password
Card type
Login ID
Password
Card type
Login ID
Password
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
ADDITIONAL ONLINE ACCOUNTS
Bill Payment: Website
Login ID
Password
Website
Login ID
Password
Email Accounts:
Email Address
Password
Email Address
Password
Email Address
Password
OTHER ACCOUNTS (Facebook, Twitter,etc.) Account
Login ID
Password
Account
Login ID
Password
MISCELLANEOUS ASSETS
Listed here are assets as fraternal and benevolent memberships, royalty rights, patents, debts owed to me, and other sources of income, such as trust income and pensions (Veteran’s, Civil Service, Union, etc.), that might not be readily located.
MISCELLANEOUS LIABILITIES
Mortgages, notes, and other debts not noted elsewhere. Description: Description: Description: Description: I have
LEGAL MATTERS
have no
legal cases pending.
Description: Attorney: Date Initiated: Court: CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
TAX RECORDS & RETURNS
Copies of previous tax returns filed are located at: Party who prepared or assisted in tax returns: Work sheets and evidence in support of returns are located at: Current withholding tax forms and receipts received from my employer are located at:
BURIAL
I do do not own a cemetery lot. Cemetery Lot:
Name of Cemetery
Describe Location
Deed located at: There is is not prevision for perpetual care. I have given instructions regarding my funeral in: Will Letter Other: List membership in lodges or fraternal organizations providing cemetery benefits: My preference for burial would be at: Name of Cemetery
I do do not have a prepaid funeral. Location of prepaid funeral documents:
RELIGIOUS AFFILIATION
List Church or Temple Address Pastor or Rabbi Phone CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
PERSONS FAMILIAR WITH MY AFFAIRS Please find name, address and phone number.
Attorney: Accountant – Tax Counselors: Banker: Doctor: Employer: Funeral Director: Insurance Agent: Executor of Estate: Fraternal or Professional Groups: (Please notify) Relatives and Personal Friends: (Please notify)
Latest copy of my will is located at:
CONFIDENTIAL. KEEP IN A SECURE LOCATION. PREVENT UNAUTHORIZED DISCLOSURE.
You Know the Firm. Experience the Difference.
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501 WEST COLFAX STREET PALATINE, ILLINOIS 60067 847-705-7555 www.lavellelaw.com
