This form might be useful in planning for your survivors. You can type into the form and save it or print it out and write the details on the paper. Consider preparing a separate form for each adult. Feel free to adapt this document to express your needs and leadings.

Anyone who has served as an executor can appreciate the planning and clear communication of the deceased person. Having the necessary information at hand can save endless hours of searching, or expensive legal proceedings.

Expressing your wishes clearly can protect your family from service providers who might benefit by overselling services to grieving family members. To be clear, some funeral directors will lead grieving family members to think that the deceased person may have wanted more expensive services, caskets, or other items. A clear expression of your wishes can protect your family from spending too much.

Every adult should prepare and update a Last Will and Testament. If someone dies without a will, someone will have to apply to court to have an executor appointed. This will typically require posting a bond, which requires paying a premium to an insurance company. Legal and court fees are typically higher for estates without a will. Moreover, what are the odds that state law and judicial proceedings would result in the distribution of your assets that you would want?

Every adult should also have a durable power of attorney. I recall a Friend whose adult son was in a traffic accident in another state. Since the son had never made out a durable power of attorney, the out-of-state hospital could not release any information about the son to his parents. When my daughter turned 18, I was fortunate that she agreed to make out a will and durable power of attorney.

Wills should NOT be kept in safe deposit boxes, or in safes. They belong where the executor can find it quickly. In fact, why not give it to the executor now?

This form is adapted from a form provided by:

http://agoodgoodbye.com

Information Needed for a Death Certificate

Full Name (official first, middle and last on birth certificate):

Nick Name (what your friends usually call you):

Birth Name (if different):

Date of Birth:

Place of Birth (city and state or foreign country):

Social Security Number:

Residence Address (street, city, state, zip):

Gender:

Father’s Full Name:

Mother’s Full Name at Birth:

Marital Status (check one): __ single __ married __ divorced __ widow/widower

Surviving Spouse’s Name (including name at birth):

Served in U.S. Armed Forces (yes or no):

Preferred Method of Disposition:

Race:

Highest level of education:

Usual occupation (kind of work during career):

Veteran Information

Service/Branch:

Date and Place of Enlistment:

Date of Discharge:

Rank and Service Number:

Veterans’ Administration Claim Number:

War/Conflicts/Tours of Duty:

Commendations Received:

Marital History

Current Marriage (name of spouse and date of marriage):

Previous Marriages (Names, dates of wedding and divorce finalization, current address and phone number of ex, notes):

Religious information

Religion:

House of Worship:

Address and Telephone:

Persons to Contact:

Codes, Combinations and Online Passwords

Mark down user name and passwords for key online activities. Remaining live online after your demise can be problematic for your survivors. Note other codes or combinations needed to access important information.

Computer log-on or administrative access:

Internet Service Provider:

Email Provider:

Facebook Account:

Twitter Account:

Cell Phone Account:

Burglar alarm code/password:

Online Banking/Investment Accounts:

Online Merchant Accounts:

Web Site(s) Administration (including FTP account names and passwords:

Safe combination:

Family to Notify

For each as applicable, enter name, city/state, telephone, email, and notes.

Spouse:

Parent:

Parent:

Children:

Grandchildren:

Siblings:

Others:

Friends and Others to Notify

Name, Telephone, Email:

Executor (Name, address, telephone, email)

Insurance Agent/Company (Name, address, telephone, email)

Attorney (Name, address, telephone, email)

Financial Advisor/CPA (Name, address, telephone, email)

Other Professional Advisors (Name, address, telephone, email)

Obituary News Bits

In addition to helping draft an informative obituary, these details can be used to notify other people who will want to know about the death.

Education Include name of school, city and state, degree earned, dates attended.

High School:

Community College or Trade School:

University:

Graduate Degree(s):

Membership in Alumni Association(s):

Career Highlights Note organizations worked for and dates, achievements, awards, etc.

Hobbies and Interests Note any pursuits or passions that play a large role in life.

Organizations to Contact

This is helpful to alert people who may be involved in your professional, community, or volunteer life. This can include unions, fraternal organizations, professional interest groups, volunteer services, and other community contacts. List the name of the organization, address, telephone, and if possible, a specific contact person. If no longer a member, you may want to note the dates of membership. Note if you’d like to name one of these organizations as a memorial donation beneficiary.

Organizations (including contact information):

Newspapers or Publications for Obituary

List the local newspapers or trade publications that would be appropriate for either a paid obituary announcement or a news obit. Having the publication name, telephone and web site address handy is one less thing to stress about.

Publications:

Document Locator

Let your family know where the important documents are kept. Here’s a quick run-down of what documents and other information your family will need to put their hands on if there’s a medical emergency or death. Note “yes or no” regarding each piece, where it’s located, an account number or other reference as needed, and any other notes.

Will:

Living Will:

Living Trust:

Medical Power of Attorney:

Durable Power of Attorney:

Cemetery Plot Deed:

Body/Organ Donor Information:

Safe Deposit Box:

Safe Deposit Box Key:

P.O. Box:

P.O. Box Key:

Automobile Title(s):

Birth Certificate:

Passport:

Divorce Papers:

Life Insurance:

Health Insurance:

Long Term Care or Disability Insurance:

Auto/Home Insurance:

Savings Accounts:

Checking Accounts/Checkbooks:

Credit Cards (account #s, toll-free phone):

Annuities:

Mortgage Papers/Deeds:

Income Tax Records:

Retirement Plans:

Government Benefit Statements:

Espressing Your Values

Have you considered the following provisions in your will and other planning documents?

• A Declaration for Life. “If my death was caused by any wrongful act, or if I was the victim of any crime before my death, it is my wish that no capital punishment be imposed for such crimes. As I believe in the sanctity of all life, it would be too great an irony for me to bear if my life was used to justify the taking of another.”

• Whole Body Donation. Most medical schools need cadavers. Medical students need the practice with cadavers so that their medical skills will develop before they practice medicine on live patients. Whole Body Donation also protects your heirs from funeral home expenses.

• Considering charitable interests. Have you considered using your will to express support for charities that are important to you? If one has family members with unmet needs, then charitable contributions might not be appropriate. However, it is a time when a person can set an example and support a cause or organization.

Your Final Wishes

Sketch out what you envision for your memorial service.

Pre-need arrangements made (if yes, name funeral provider and contact info):

Pre-need funding done (if yes, name company and contact info):

Disposition of Remains: (Burial, cremation, donation of body, other)

Prefer a funeral (body present) or a memorial service (cremains or not present):

Prefer a wake, viewing, picnic, party, other gathering:

If donating to science or medical school, list arrangements:

Cremated remains: (Bury, scatter, keep in urn, columbarium, share with family, other)

Cemetery plot or mausoleum crypt purchased (list section, block, plot):

Casket preference (material and price range):

Open or closed casket:

Embalming preference (yes or no):

Clothing, jewelry, other burial item preferences (such as eyeglasses):

Marker preference (headstone or plaque):

What do you want on your tombstone?

Location of funeral/memorial service:

Favorite flowers:

Memorial gifts in lieu of flowers:

Officiating clergy or friends:

Speakers – eulogy and readers:

Readings:

Music selections, musical instruments:

Casket bearers:

Honorary pallbearers:

Other special instructions: