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Estate and Elder Law

Information Sheet for Personal Representative or Next of Kin

Information for My Personal Representative or Next of Kin
 
This document is intended to assist my personal representative or next of kin by providing personal information to help with the administration of my estate and by notifying my personal representative and next of kin of my wishes regarding the disposal of my remains.
 
Helpful Information
 
My social security number is _________________________________
 
Location of my will __________________________________________
 
Location of insurance policies _______________________________
 
My attorney is _______________________________________________
 
I have bank accounts at the following banks:
_______________________________   ______________________________
Bank                                                         Acct. No.
 
_______________________________   ______________________________
Bank                                                         Acct. No.
 
_______________________________   ______________________________
Bank                                                         Acct. No.
 
_______________________________   ______________________________
Bank                                                         Acct. No.
 
_______________________________   ______________________________
Bank                                                         Acct. No.
 
I ____________ (do, do not) have a safety deposit box. My safety deposit box is located at _______________________, and the location of the key is _____________________________________________________________.
 
I own the following real estate:
_________________ ______________________________________________
________________________________________________________________
________________________________________________________________
 
Location of deeds ______________________________________________
 
I have the following stocks, bonds, contracts or other valuables, and have listed the location of each: __________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
 
Other information:______________________________________________ ________________________________________________________________
________________________________________________________________
________________________________________________________________
 
Signature:__________________________
 
Address:____________________________
____________________________________
 
Date compiled:______________________
 
Disposal of My Remains
 
It is my wish that my remains be ______________ (cremated, buried, entombed)
 
It is my wish that my ashes be ___________________ (scattered, buried, given to X)
 
If burial is preferred, cemetery arrangements ___________________ (have been, must be) made. If previously arranged: ____________________________________ (cemetery, city)
 
I ___________ (do, do not) want a service. If a service is held, I prefer a _____________________________ (memorial or funeral*). I would like the following funeral home to handle my arrangements:____________________________________________
 
If a service is held, I would like it held in a ________________ (church, residence, other)
 
If a church, the name and address is: _________________________________
 
I _________________ (do, do not) want newspaper notices published.
 
 I ________________ (do, do not) prefer memorial gifts in lieu of flowers. I request that any memorial gifts be sent to the following organization(s): _______________________________________________________________
_______________________________________________________________
 
I _______________ (do, do not) wish to donate such organs, bone or tissue, at the time of my death, as may be considered medically useful. This also authorizes donations of pace maker, if applicable.
 
I _______________ (do, do not) wish to donate my eyes, at time of death.
 
I _______________ (do, do not) wish to donate my body, at time of death, to the closest Medical Teaching Facility.
 
________________________________
Name
 
Date:-__________________________
 
*memorial service indicates without the deceased present; funeral service indicates with the deceased present
 
 
 

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