LETTER OF LAST INSTRUCTION WORKSHEET
(Keep with your important papers)
LOCATION OF PERSONAL PAPERS
Cross out the items that do not apply
Birth and Baptismal Certificates ______________________________________
Communion and Confirmation Certificates ______________________________________
Marriage Certificate ______________________________________
Divorce Decree ______________________________________
Will ______________________________________
Living Will/Healthcare Power of Attorney ______________________________________
Military Records ______________________________________
Naturalization papers ______________________________________
Durable Power of Attorney ______________________________________
Living Trust ______________________________________
Inventory of personal property ______________________________________
Inventory of safe deposit box ______________________________________
Adoption papers ______________________________________
Insurance Policies ______________________________________
Vehicle titles and registrations ______________________________________
Loan and mortgage documents ______________________________________
Deeds ______________________________________
Prepaid funeral contracts ______________________________________
Cemetery plot documents ______________________________________
Stock Certificates ______________________________________
Savings Bonds ______________________________________
Other ______________________________________
DOCTORS/PHYSICIANS
Name and type ______________________________________
Address and phone ______________________________________
Name and type ______________________________________
Address and phone ______________________________________
Name and type ______________________________________
Address and phone ______________________________________
Name and type ______________________________________
Address and phone ______________________________________
Name and type ______________________________________
Address and phone ______________________________________
WHAT TO DO FIRST
Call relatives, friends, neighbors (name and phone) ____________________________
______________________________________
______________________________________
______________________________________
______________________________________
Notify my employer (name and phone) ______________________________________
Call my attorney (name and phone) ______________________________________
Make arrangements with funeral home ______________________________________
(See details below)
Request multiple certified copies of the death certificate
Contact Social Security (Number and location of card) ________________________________
Contact insurance companies
(See below)
Notify bank that holds home mortgage ______________________________________
Other ______________________________________
CEMETERY AND FUNERAL
My choice of funeral home ______________________________________
Type of funeral preferred ______________________________________
Other (cremation or other instructions) ______________________________________
Religious preference ______________________________________
Cemetery plot location ______________________________________
Cemetery plot documents location (give to ______________________________________
funeral director)
FACTS FOR THE FUNERAL DIRECTOR
My full name ______________________________________
Address ______________________________________
Marital status, and spouse info if applicable ______________________________________
Date and place of birth ______________________________________
Father and mother’s name ______________________________________
Military service, if applicable ______________________________________
Social Security number ______________________________________
FINANCIAL INFORMATION
SAVINGS, CHECKING, AND MONEY MARKET ACCOUNTS AND CERTIFICATE OF DEPOSIT
Account number and type ______________________________________
Bank and address ______________________________________
Name(s) on account and type of ownership ______________________________________
Location of passbook, checkbook, as ______________________________________
applicable
Account number and type ______________________________________
Bank and address ______________________________________
Name(s) on account and type of ownership ______________________________________
Location of passbook, checkbook, as ______________________________________
applicable
Account number and type ______________________________________
Bank and address ______________________________________
Name(s) on account and type of ownership ______________________________________
Location of passbook, checkbook, as ______________________________________
applicable
Account number and type ______________________________________
Bank and address ______________________________________
Name(s) on account and type of ownership ______________________________________
Location of passbook, checkbook, as ______________________________________
applicable
INVESTMENT ACCOUNTS
Account number and type of account _____________________________________
Company and address ____________________________________
Agent name and phone _____________________________________
Name(s) on account _____________________________________
Account number and type of account _____________________________________
Company and address _____________________________________
Agent name and phone _____________________________________
Name(s) on account _____________________________________
Account number and type of account _____________________________________
Company and address _____________________________________
Agent name and phone _____________________________________
Name(s) on account _____________________________________
STOCKS
Company and number of shares _____________________________________
Name(s) of owners _____________________________________
Purchase price and date _____________________________________
Location of certificate(s) _____________________________________
Company and number of shares _____________________________________
Name(s) of owners _____________________________________
Purchase price and date _____________________________________
Location of certificate(s) _____________________________________
Company and number of shares _____________________________________
Name(s) of owners _____________________________________
Purchase price and date _____________________________________
Location of certificate(s) _____________________________________
BONDS, NOTES, BILLS
Issuer _____________________________________
Owner(s) _____________________________________
Face amount _____________________________________
Purchase price and date _____________________________________
Maturity date _____________________________________
Location _____________________________________
Beneficiaries, if any _____________________________________
Issuer _____________________________________
Owner(s) _____________________________________
Face amount _____________________________________
Purchase price and date _____________________________________
Maturity date _____________________________________
Location _____________________________________
Beneficiaries, if any _____________________________________
Issuer _____________________________________
Owner(s) _____________________________________
Face amount _____________________________________
Purchase price and date _____________________________________
Maturity date _____________________________________
Location _____________________________________
Beneficiaries, if any _____________________________________
SAFETY DEPOSIT BOX
Bank and address ______________________________________
Box number and location of key(s) ______________________________________
Name(s) owner ______________________________________
Location of list of contents ______________________________________
CREDIT CARDS
Company ______________________________________
Account number ______________________________________
Name(s) on card ______________________________________
Phone ______________________________________
Credit life? ______________________________________
Company ______________________________________
Account number ______________________________________
Name(s) on card ______________________________________
Phone ______________________________________
Credit life? ______________________________________
Company ______________________________________
Account number ______________________________________
Name(s) on card ______________________________________
Phone ______________________________________
Credit life? ______________________________________
OUTSTANDING LOANS OTHER THAN MORTGAGE
Institution holding loan ______________________________________
Address and phone ______________________________________
Name(s) on loan ______________________________________
Account number and type of loan ______________________________________
Location of contract ______________________________________
Collateral, if any ______________________________________
Credit Life on loan? ______________________________________
Institution holding loan ______________________________________
Address and phone ______________________________________
Name(s) on loan ______________________________________
Account number and type of loan ______________________________________
Location of contract ______________________________________
Collateral, if any ______________________________________
Credit Life on loan? ______________________________________
INSURANCE POLICIES
LIFE INSURANCE
Location of policies ______________________________________
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of beneficiaries ______________________________________
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of beneficiaries ______________________________________
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of beneficiaries ______________________________________
ACCIDENT INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of beneficiaries ______________________________________
AUTOMOBILE INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of covered parties ______________________________________
HOMEOWNER’S INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
MEDICAL INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of covered individuals ______________________________________
MORTGAGE INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
LONG TERM DISABILITY INSURANCE
Company and address ______________________________________
Agent name and phone ______________________________________
Policy number ______________________________________
Name of owner ______________________________________
Name of insured ______________________________________
Name(s) of covered individuals ______________________________________
PROPERTIES
1. Address ______________________________________
______________________________________
Owner(s) ______________________________________
Location of deed and other papers ______________________________________
Outstanding mortgage, loan, or land contract______________________________________
information location ______________________________________
Initial purchase price and date ______________________________________
Location of improvement receipts and other expenses _____________________________
2. Address ______________________________________
______________________________________
Owner(s) ______________________________________
Location of deed and other papers ______________________________________
Outstanding mortgage, loan, or land contract______________________________________
information location ______________________________________
Initial purchase price and date ______________________________________
Location of improvement receipts and other expenses _______________________________
VEHICLES
Year, make, and model ______________________________________
Location of title ______________________________________
Location of keys ______________________________________
Location of registration ______________________________________
Name(s) of owner ______________________________________
Year, make, and model ______________________________________
Location of title ______________________________________
Location of keys ______________________________________
Location of registration ______________________________________
Name(s) of owner ______________________________________
VETERAN INFORMATION
Years served ______________________________________
Wounded or disabled? ______________________________________
ID number ______________________________________
Receiving pension or disability? ______________________________________
VA Life Insurance Policy ______________________________________
INCOME TAX INFORMATION
Location of previous years’ returns ______________________________________
Location of current year’s records, receipts, etc. ______________________________________
Name and phone of tax preparer ______________________________________
PETS
Type, name, breed, color ______________________________________
Microchip number ______________________________________
Special needs ______________________________________
Veterinarian name, address, phone ______________________________________
______________________________________
Person(s) who will care for pet, name, address, and phone _____________________________
__________________________________________________
Type, name, breed, color __________________________________________________
Microchip number ______________________________________
Special needs ______________________________________
Veterinarian name, address, phone ______________________________________
______________________________________
Person(s) who will care for pet, name, address, and phone _____________________________
______________________________________________________________
RELATIVES AND FRIENDS TO INFORM
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
Name and relation ______________________________________
Address and phone ______________________________________
PERSONAL EFFECTS
People you would like to receive certain items:
ITEM PERSON
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________
________________________________ _____________________________________