|
|
(You may copy and paste this document into WORD and then print it out or complete it on your computer)LETTER OF INSTRUCTIONS
Vital Statistics
Full Name _______________________________________________________________ Address_________________________________________________________________ Date of Birth_________________ Birthplace_________________________________ Social Security # _________________________________________________________ Length of time in your State of residency and in the US if applicable _______________ Military record __________________________________________________________ Occupation _____________________________________________________________ Father’s Name_______________________________________ Birthplace_____________________________________ Mother’s Name______________________________________ Birthplace_____________________________________ Children’s Name(s) Birth Date(s) __________________________________________________ _______________________ __________________________________________________ _______________________ __________________________________________________ _______________________ __________________________________________________ _______________________ __________________________________________________ _______________________ Grandchildren’s Name(s) Birth Date(s) __________________________________________________ _______________________ __________________________________________________ _______________________ __________________________________________________ _______________________ Brother’s / Sister’s Name(s) _________________________________ ________________________________ _________________________________ ________________________________
Important People Provide contact information on the important people that affect your health, financial and legal well being. Physician Address
Phone # Physician/Specialist Address
Phone # Dentist Address
Phone # Other Care Givers Address Phone # Attorney Address
Phone # Financial Planner / Advisor Address
Phone # Acccountant Address
Phone # Banker Address
Phone # Insurance Agent Address
Phone # Other Address
Phone # Important Personal Papers Provide the location of these and any other important papers that will help your heirs understand you wishes in regards to your health, financial and legal well being. Wills
Durable Power of Attorney for Healthcare / Living Will
Durable Power of Attorney for Property
Birth certificates
Military records
Marriage certificate
Social Security Card
Property Deeds
Trust Documents
Insurance Policies (Attach list with company name, policy #, agent, phone #. )
Custodial Accounts Insurance Trusts Trusts you may currently be trustee for Loans outstanding other than mortgage (Attach list with company name including location of payment booklets)
Loans you may guarantee
Promissory notes owed to you
Income tax returns
Investment Certificates / Stock Certificates etc.
Other
Location of Important Personal Items & Information Provide the location of these items as well as any other important information. Safe deposit Box & Key
Post office Box & Key or Combination
"Hidey Hole" (most people have a fireproof safe or other "safe" place where they store things in their homes)
Home File Cabinets
Other Information On Benefits Due You Or Your Heirs Attach additional pages as necessary to fully documents benefits due you and your heirs.
Social Security
Veterans Affairs
Life insurance
Other
Information Required If You Become Disabled
If I am disabled, my life insurance policy (allows/does not allow) for pre-payment of death benefits to support me.
If I am disabled, my life insurance policy (allows/does not allow) you to stop making premium payments.
If I am disabled, my disability insurance (allows/does not allow) you to stop making premiums.
It is my desire that the persons holding my Durable Power of Attorney(s) act in my behalf rather than a guardian being appointed, unless my family believes guardianship is necessary. I have appointed the following persons (Listed in the previously mentioned documents) to act on my behalf if I become disabled:
In the event of my incapacity (I do/do not want) to be kept home as long as possible, taking into account the cost. Other wishes you might have in the event of your disability. Information On Your Investments If a broker or financial advisor holds your investments, provide the location where you keep the most current statements. The name of any financial advisor should be documented under important people above. If you have other investments, be specific about the type, where the paperwork is located, amount invested, to whom the investment was issued, and any professional or other individual that can assist your heirs understand the investment. (Attach additional pages as necessary) Stocks / Bonds
Mutual Funds
IRAs
Real Estate
Annuities
Life Insurance
Other
Wishes & Specific Requests Any specific requests you may have regarding mementos, specific pieces of furniture or silver, or any gifts not specified in your will should be listed so your heirs are able to insure your wishes are carried out and the proper people receive your property. Please attach a separate document to this letter of instruction that delegates those items you wish to give to specific people. If you prepare a separate document you should date and sign it. In The Event Of My Death
I (have/have not paid) my burial costs, for my burial plot, for my casket. If I have, the information can be found:
I request that following funeral home / mortuary handles my funeral arrangements:
I (do/do not) want to be cremated. I request that __________________________of ________________________perform the funeral service (Provide contact information – Also provide any other details and arrangement you may have made.):
I (do/do not) wish to have a Church Service. If yes, provide the name of the church, address, person to contact along with any special requests as to the nature of the service you desire, i.e. readings, music etc.
I (do/do not) wish to have Graveside Service.
If I do have a Church Service, I request that the following people be asked to be Pallbearers:
I request that the following people be asked to be Honorary Pallbearers:
I request that the following inscription be engraved on my Memorial Stone: ____________________________________________________________________ ____________________________________________________________________ I (do/do not) wish to have my organs available for donation. List any newspapers that you wish to receive obituary information:
I request that the following people be notified upon the event of my death (Attach additional pages as necessary): Name Address Telephone __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________ __________________________ ___________________________ ___________
I have signed this family Letter of Instructions this ___day of _______________, in the year of _______. This document is not intended to replace my will or other estate planning documents signed by me. However, it is my express desire that each family member, executor, trustee and guardian will use this letter and the other documents signed by me in making any discretionary decisions for me and my family.
____________________________________ ______________________________ (Print Name) (Signature) Copies of this document were delivered to:
|