THE

EVERY LITTLE
detail
BOOK
A LEAVE BEHIND FOR MY LOVED ONES
EXPECT THE BEST.
PREPARE FOR THE WORST.
CAPITALIZE ON WHAT COMES.
ZIG ZIGLAR

THIS EVERY LITTLE DETAIL BINDER

BELONGS TO:

AND WAS LAST UPDATED ON:

Copyright The Purposeful Penny. All Rights Reserved.

Page 2
TABLE OF CONTENTS
INTRODUCTION (4) MONTHLY BUDGET (92)
BUDGET SOFTWARE (93)
INSTRUCTIONS (5) INCOME SOURCES (93)
MONTHLY BUDGET OVERVIEW (95)
PERSONAL INFORMATION (6) MONTHLY BUDGET DETAILS & INSTRUCTIONS (96)
BASIC PERSONAL INFORMATION (7)
PREVIOUS ADDRESSES (7) HOUSEHOLD INFORMATION
TRAVELER INFORMATION (8) HOUSEHOLD TAXES (98)
EDUCATIONAL BACKGROUND (9) HOUSEHOLD SCHEDULE (98)
EMPLOYMENT INFORMATION & HISTORY (10) HOUSEHOLD SERVICE PROVIDERS (99)
MILITARY INFORMATION & HISTORY (11) HOUSEHOLD FAVORITES (103)
GROUPS & ORGANIZATIONS (12) HOUSEHOLD PASSWORDS (105)
HOUSEHOLD FINAL WISHES (106)
ESTATE PLAN (21)
WILL & TRUST DETAILS (22) CHILDREN (107)
LETTER OF INSTRUCTION (22) PERSONAL INFORMATION (108)
POWER OF ATTORNEY (POA) (23) MEDICAL INFORMATION (109)
LIVING WILL & HEALTHCARE POA (23) SCHEDULE INFORMATION (111)
BENEFICIARY DESIGNATION (23) CHILD SERVICE PROVIDERS (115)
GUARDIANSHIP DESIGNATION (32) SCHOOL INFORMATION (118)
OTHER ESTATE PLAN DETAILS (33) CHILD FAVORITES (120)

FINAL WISHES & ARRANGEMENTS (34) PETS (124)

REPRESENTATIVE FOR FUNERAL ARRAGEMENTS (35) PERSONAL INFORMATION (125)
FINAL RESTING DETAILS (35) MEDICAL INFORMATION (126)
FUNERAL OR MEMORIAL SERVICE DETAILS (36) CARE & SCHEDULE INFORMATION (128)
PRE-ARRAGEMENTS MADE (38) PET SERVICE PROVIDERS (130)
PRE-ARRANGEMENTS PAID FOR (38) PET FAVORITES (132)
AFTER DEATH INSTRUCTIONS (133)
ASSETS (43)
BANK ACCOUNTS (44) MEDICAL INFORMATION (134)
INVESTMENTS (46) GENERAL MEDICAL INFORMATION (135)
RETIREMENT ACCOUNTS (48) DOCTORS (135)
DEBTS OWED TO YOU (50) PRESCRIPTIONS (138)
REAL ESTATE (51) ILLNESSES/DISORDERS (139)
INCOME PROPERTIES (52) MEDICAL FAMILY HISTORY (140)
MOTOR VEHICLES (53) ALLERGIES (141)
OTHER VALUABLES (55) PREVIOUS SURGERIES (141)
FSA & HSA ACCOUNTS (142)
LIABILITIES (57)
LIABILITY SUMMARY (58) PRIVATE BUSINESS INFORMATION (151)
CREDIT CARDS (59) GENERAL BUSINESS INFORMATION (152)
STUDENT LOANS (61) EMPLOYEES (152)
PERSONAL LOANS (64) BUSINESS FINANCIAL INFORMATION (154)
MORTGAGE DEBT (65) BUSINESS SERVICE PROVIDERS (157)
CAR & MOTOR VEHICLE LOANS (67) BUSINESS LOGINS & PASSWORDS (162)
LOANS FROM FRIENDS & FAMILY (69) BUSINESS AFTER DEATH WISHES (170)

OTHER BILLS & ACCOUNTS (70) LOGINS & PASSWORDS (171)

UTILITIES (71) ELECTRONICS PASSWORDS (172)
PHONE & INTERNET (72) SOCIAL MEDIA ACCOUNTS (173)
FITNESS MEMBERSHIPS (73) EMAIL ACCOUNTS (174)
SUBSCRIPTIONS (74) ONLINE BILLS & ACCOUNT LOGIN INFO (176)
MISC HOUSEHOLD EXPENSES (76) PHYSICAL STORAGE (183)
OTHER MISC EXPENSES (77)
IMPORTANT DOCUMENTS (186)
INSURANCE (78)
PROPERTY INSURANCE (79) IMPORTANT CONTACTS (189)
MOTOR VEHICLE INSURANCE (81)
HEALTH INSURANCE (83) LETTERS TO LOVED ONES (196)
DISABILITY INSURANCE (85)
LIFE INSURANCE (86)
PET INSURANCE (88)
VALUABLES INSURANCE (89)
OTHER INSURANCE (91)
Page 3
 Meet the Author

Paige
Pritchard
Paige Pritchard is a certified life

coach and money coach who helps

ambitious women overcome their

overspending so they can reach their

full financial potential.

Through her years of educating and coaching women, Paige has developed a fresh

and unique blend to money management, merging the "how-to's" of money with

money mindset work. She's a firm believer that you need to master both the math and

mental aspects of money to reach your full financial potential.

Her mission is to be a living example to other women of what is possible financially

when you manage your mindset and emotions around money. She believes that when

women can make empowered choices with their spending they are equipped to build

more wealth and live the lives of their dreams.

She holds a bachelors degree in Marketing from Texas A&M University, a dual-

concentration MBA in Marketing & Finance from the University of Michigan -

Dearborn, and is also a Certified Life Coach through The Life Coach School.

She lives in Dallas Texas with her husband Ryan and two fur-children Ellie & Poppy

and she has a little girl on the way due July 2022.
INSTRUCTIONS
To Make The Most of Your Legacy Binder...
Fill out all the sections that are relevant to you in the workbook.
1 You can either print out the PDF and fill it in by hand or type in
the fields within the PDFs. If there are sections that are not
relevant to your life (i.e. Pets, Children, Business Information)
then simply don't include those sections in your binder

Once complete, share the existence of the binder with 1-2

2 trusted family members or friends. Make sure they are aware of
the folder, and know where to find it should anything happen.

To protect your personal information, place your completed

3 binder in a safe and secure location such as a safe or a safety
deposit box.

Every six months to one-year, review your binder to make sure

4 all information is still accurate, and make any necessary
updates needed to keep your information current.

TIPS & TRICKS

There is a lot of information in this binder. I suggest you taking it section by section. Tackle one
1 section every couple of days. If you do that, you will have the entire binder completed in 1-2
months. After that, you can monitor it occasionally and update any changes that are needed.

If you run out of space in certain sections, just re-print the page as many times as you need until
2 all your information is covered.

I encourage you to print off the PDF, place the contents in a binder, and feel free to add divider
3 tabs, clear slip pockets to hold documents and letters, etc which will make your binder clean and
organized.

Page 5
 personal
information
PERSONAL INFORMATION
This section outlines important PERSONAL INFORMATION including:
• Basic Personal Information • Employment Information & History
• Previous Addresses • Military Information & History
• Traveler & ID Information • Groups & Organizations
• Educational Information • Credit Reports

BASIC PERSONAL INFORMATION (Person 1)

BASIC PERSONAL INFORMATION
Full Name
Address
City, State, Zip
Date of Birth
Birth City, State
SSN
Mother’s Name
Mother’s Maiden Name

Father’s Name
Phone
Email Address

PREVIOUS ADDRESSES:
PREVIOUS ADDRESS #1
Address
Dates Occupied
Rented/Owned?
Who Lived There?

PREVIOUS ADDRESS #2
Address
Dates Occupied
Rented/Owned?
Who Lived There?
PERSONAL INFORMATION
TRAVELER & ID INFORMATION (PERSON 1):

DRIVER’S LICENSE
Driver’s License Number
Driver’s License State
Driver’s License Exp Date
Where to Find
Driver’s License

PASSPORT
Name on Passport
Passport Number
Passport Issuing Country
Passport Issuing Date
Passport Exp Date
Where to Find Passport

TSA PRE CHECK/GLOBAL ENTRY

Known Traveler #
Expiration Date

TRAVELER REWARDS PROGRAMS

Name of Airline/Hotel/Etc. Loyalty Program Number
PERSONAL INFORMATION
EDUCATIONAL INFORMATION (PERSON 1)

EDUCATION BACKGROUND
High School
Name of High School
Dates Attended
Undergraduate Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA
Master’s Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA
PHD or Doctorate Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA

OTHER EDUCATIONAL CERTIFICATIONS OR AWARDS

Below, list any other certifications or educational awards you have received.
PERSONAL INFORMATION
CURRENT EMPLOYMENT INFORMATION (Person 1)

CURRENT EMPLOYER
Company Name
Start Date
Current Title
Current Salary
Starting Salary
Previous Titles
Boss & Contact Info
Awards Received &
Major Contributions

PREVIOUS EMPLOYMENT INFORMATION (Person 1)

PREVIOUS EMPLOYER #1
Company Name
Dates Employed
Starting Salary Ending Salary
Titles Held
& Dates
Awards Received & Card CVV
Major Contributions As Of

PREVIOUS EMPLOYER #2
Company Name
Dates Employed
Starting Salary Ending Salary
Titles Held
& Dates
Awards Received & Card CVV
Major Contributions As Of
* As a suggestion, include a copy of your most current resume in this section as well.
PERSONAL INFORMATION
MILITARY INFORMATION & HISTORY (Person 1)
MILITARY INFORMATION
Military Branch
Military Occupation
Training & Schools
Completed
Promotions & Dates
Final Rank
Date Enlisted Discharge Date

Combat &
Overseas Service

Medals & Honors

Names & Contact

Information of
Others you Served
With
PERSONAL INFORMATION
GROUPS & ORGANIZATIONS (Person 1)
ORGANIZATION #1
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #2
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #3
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #4
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received
PERSONAL INFORMATION
CREDIT SCORE & REPORT (Person 1)
Below, record your current credit score with each of the 3 major credit bureaus. Under
the Fair Credit Reporting Act, you are entitled to free copies of your credit reports once a
year. To get your free copy, visit AnnualCreditReport.Com.

Once you have your credit reports, include a copy of each of your reports in this section.

CURRENT CREDIT SCORES

Experian Score As Of
Equifax Score As Of
TransUnion Score As Of

Below, write any details about your credit score or reports that are important to note,
such as major factors that are currently impacting your score (i.e. bankruptcy) or if you
are currently impacting your score (i.e. bankruptcy) or if you are currently disputing
inaccuracies on your report to be corrected.
PERSONAL INFORMATION
The information in this section is the same as the above for your spouse. If you are single,
there is no need to fill out the below information and you can move to the next section.

BASIC PERSONAL INFORMATION (Person 2)

BASIC PERSONAL INFORMATION
Full Name
Address
City, State, Zip
Date of Birth
Birth City, State
SSN
Mother’s Name
Mother’s Maiden Name

Father’s Name
Phone
Email Address

PREVIOUS ADDRESSES (Person 2)

PREVIOUS ADDRESS #1
Address
Dates Occupied
Rented/Owned?
Who Lived There?

PREVIOUS ADDRESS #2
Address
Dates Occupied
Rented/Owned?
Who Lived There?
PERSONAL INFORMATION
TRAVELER & ID INFORMATION (Person 2):

DRIVER’S LICENSE
Driver’s License Number
Driver’s License State
Driver’s License Exp Date
Where to Find
Driver’s License

PASSPORT
Name on Passport
Passport Number
Passport Issuing Country
Passport Issuing Date
Passport Exp Date
Where to Find Passport

TSA PRE CHECK/GLOBAL ENTRY

Known Traveler #
Expiration Date

TRAVELER REWARDS PROGRAMS

Name of Airline/Hotel/Etc. Loyalty Program Number
PERSONAL INFORMATION
EDUCATIONAL INFORMATION (PERSON 2)

EDUCATION BACKGROUND
High School
Name of High School
Dates Attended
Undergraduate Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA
Master’s Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA
PHD or Doctorate Degree
Name of College
Dates Attended
Degree Earned
Major/Minor
GPA

OTHER EDUCATIONAL CERTIFICATIONS OR AWARDS

Below, list any other certifications or educational awards you have received.
PERSONAL INFORMATION
CURRENT EMPLOYMENT INFORMATION (Person 2)

CURRENT EMPLOYER
Company Name
Start Date
Current Title
Current Salary
Starting Salary
Previous Titles
Boss & Contact Info
Awards Received &
Major Contributions

PREVIOUS EMPLOYMENT INFORMATION (Person 2)

PREVIOUS EMPLOYER #1
Company Name
Dates Employed
Starting Salary Ending Salary
Titles Held
& Dates
Awards Received & Card CVV
Major Contributions As Of

PREVIOUS EMPLOYER #2
Company Name
Dates Employed
Starting Salary Ending Salary
Titles Held
& Dates
Awards Received & Card CVV
Major Contributions As Of
*As a suggestion, include a copy of your most current resume in this section as well.
PERSONAL INFORMATION
MILITARY INFORMATION & HISTORY (Person 2)
MILITARY INFORMATION
Military Branch
Military Occupation
Training & Schools
Completed
Promotions & Dates
Final Rank
Date Enlisted Discharge Date

Combat &
Overseas Service

Medals & Honors

Names & Contact

Information of
Others you Served
With
PERSONAL INFORMATION
GROUPS & ORGANIZATIONS (Person 2)
ORGANIZATION #1
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #2
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #3
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received

ORGANIZATION #4
Group Name
Level/Title
Member Since Membership #
Main Contact Name Contact Phone
Commitment
Awards & Honors
Received
PERSONAL INFORMATION
CREDIT SCORE & REPORT (Person 2)
Below, record your current credit score with each of the 3 major credit bureaus. Under the Fair Credit
Reporting Act, you are entitled to free copies of your credit reports once a year. To get your free copy, visit
AnnualCreditReport.Com.

Once you have your credit reports, include a copy of each of your reports in this section.

CURRENT CREDIT SCORES

Experian Score As Of
Equifax Score As Of
TransUnion Score As Of

Below, write any details about your credit score or reports that are important to note,
such as major factors that are currently impacting your score (i.e. bankruptcy) or if you
are currently disputing inaccuracies on your report to be corrected.
estate
plan
 ESTATE PLAN
This section is to outline the details of your ESTATE PLAN including your:
• Will & Trust • Living Will & Healthcare POA
• Letter of Instruction • Beneficiary Designation
• Power of Attorney (POA) • Guardianship Designation

DISCLAIMER: This is simply a summary of your estate plan documents and in no

way is the information in this section legally binding.

WILL & TRUST DETAILS (Person 1)

WILL & TRUST DETAILS
Will Executor
Date Will Created Date Last Updated
Type of Will Will State
(Simple, Joint, Trust)
Attorney or Service
Used to Create Will
Attorney Contact
Information
Where is Will Stored and
How to Access?
Does a Trust Exist? YES ☐ NO ☐
Type of Trust REVOCABLE ☐ IRREVOCABLE ☐
List of Trustees

Property Within Trust

Where is Trust Stored
and How to Access?

LETTER OF INSTRUCTION (Person 1)

LETTER OF INSTRUCTION DETAILS
Do you have a
Letter of Instruction?
YES ☐ NO ☐
Where is LOI Stored and
How to Access?
 ESTATE PLAN
POWER OF ATTORNEY (Person 1)

POWER OF ATTORNEY DETAILS (POA)

POA Name
Date POA Created Date Last Updated
Attorney or Service
Used to Create POA
Attorney Contact
Information
Where is POA Stored
and How to Access?

LIVING WILL & HEALTHCARE POWER OF ATTORNEY (Person 1)

HEALTHCARE POWER OF ATTORNEY (HCPA) DETAILS

Do you have a
Living Will?
YES ☐ NO ☐
Where is Living Will
Stored and How to Access?
Name of HCPA
Date HCPA Created Date Last Updated
Attorney or Service
Used to Create HCPA
Attorney Contact
Information
Where is HCPA Stored
and How to Access?

BENEFICIARY DESIGNATION (Person 1)

Below, list the details for designations or gifts that you have outlined in your will.
Examples include homes, retirement accounts, collectibles, jewelry, etc.
ITEM #1
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT. (Person 1)

ITEM #2
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #3
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #4
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #5
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #6
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #7
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT. (Person 1)

ITEM #8
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #9
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #10
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #11
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #12
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #13
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT.
ITEM #14
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #15
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #16
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #17
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #18
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #19
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #20
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
Below is the same information as outlined previously, but for your spouses will
information. If you are single or have a Joint Will with your spouse, you can
skip this section and move to the Guardianship Designation Section.

WILL & TRUST DETAILS (Person 2)

WILL & TRUST DETAILS
Will Executor
Date Will Created Date Last Updated
Type of Will Will State
(Simple, Joint, Trust)
Attorney or Service
Used to Create Will
Attorney Contact
Information
Where is Will Stored and
How to Access?
Does a Trust Exist? YES ☐ NO ☐
Type of Trust REVOCABLE ☐ IRREVOCABLE ☐
List of Trustees

Property Within Trust

Where is Trust Stored
and How to Access?

LETTER OF INSTRUCTION (Person 2)

LETTER OF INSTRUCTION DETAILS
Do you have a
Letter of Instruction?
YES ☐ NO ☐
Where is LOI Stored and
How to Access?
 ESTATE PLAN
POWER OF ATTORNEY (Person 2)

POWER OF ATTORNEY DETAILS (POA)

POA Name
Date POA Created Date Last Updated
Attorney or Service
Used to Create POA
Attorney Contact
Information
Where is POA Stored
and How to Access?

LIVING WILL & HEALTHCARE POWER OF ATTORNEY (Person 2)

HEALTHCARE POWER OF ATTORNEY (HCPA) DETAILS

Do you have a
Living Will?
YES ☐ NO ☐
Where is Living Will
Stored and How to Access?
Name of HCPA
Date HCPA Created Date Last Updated
Attorney or Service
Used to Create HCPA
Attorney Contact
Information
Where is HCPA Stored
and How to Access?

BENEFICIARY DESIGNATION (Person 2)

Below, list the details for designations or gifts that you have outlined in your will.
Examples include homes, retirement accounts, collectibles, jewelry, etc.
ITEM #1
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT. (Person 2)

ITEM #2
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #3
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #4
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #5
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #6
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #7
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT. (Person 2)

ITEM #8
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #9
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #10
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #11
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #12
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #13
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
BENEFICIARY DESIGNATION CONT.
ITEM #14
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #15
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #16
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #17
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #18
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #19
Item Name/Description
Left to Whom?
Item Value Item Location

ITEM #20
Item Name/Description
Left to Whom?
Item Value Item Location
 ESTATE PLAN
GUARDIANSHIP DESIGNATION
If you have children who are minors and have a legal guardianship designation
established, detail that information below for each of your children.
CHILD #1
Guardian Name (s)
Guardian Relation to Self
Guardian Address Item Location
Guardian Contact Info
Other Details for Guardian

CHILD #2
Guardian Name (s)
Guardian Relation to Self
Guardian Address Item Location
Guardian Contact Info

Other Details for Guardian

CHILD #3
Guardian Name (s)
Guardian Relation to Self
Guardian Address Item Location
Guardian Contact Info
Other Details for Guardian

CHILD #4
Guardian Name (s)
Guardian Relation to Self
Guardian Address Item Location
Guardian Contact Info
Other Details for Guardian
 ESTATE PLAN
OTHER ESTATE PLAN DETAILS
Below, outline in detail any other important information or parts of your estate plan that
are not already documented in this section. Also, feel free to leave copies of important
documents pertaining to your estate plan for your loved ones to reference.
final
wishes
 FINAL WISHES
This section is to outline your FINAL WISHES including your representative for
planning your arrangements, final resting details & funeral service details.

REPRESENTATIVE FOR FUNERAL ARRANGEMENTS (Person 1)

MEMORIAL SERVICE DETAILS

Person(s) in charge of
Planning & Executing my
Final Wishes & Funeral

FINAL RESTING DETAILS (Person 1)

FINAL RESTING DETAILS
Desired Final
Resting State
(Buried, Cremated Donate to
Science, etc.)
Final Resting
Place Location
(Cemetery, Plot #, Spreading
Ashes, etc.)

Type of Casket/Urn to
Use
OPEN ☐ YES ☐
Open/Closed Casket? Embalmed?
CLOSED ☐ NO ☐
Wording to Put
on Headstone

Bury me with these

Keepsakes

Desired Clothes
to be Buried In
Funeral Home
to Use/Location/
Contact Info
Budget Set Aside for
Arrangements
Where to Find Official
Documents for
Pre-Arrangements
 FINAL WISHES
FUNERAL & MEMORIAL SERVICE (Person 1)
MEMORIAL SERVICE DETAILS
Describe the Type of
Service You Want
(Memorial Service, Graveside
Service, Service at Home, etc)

Any Other Funeral

Events Wanted?
(Viewing, Wake, Visitation, etc)
Cost
Memorial Service
Location
(Enter First & Second Choice)
Auto Pay On?

Memorial Service
Officiant
(Enter First & Second Choice)

Desired Pallbearers

Desired People to
Give Eulogy
Password
Points to Include
in Eulogy

Desired Readings,
Prayers, or Poems
to be Read

Above Readings to
be Given By

Desired Songs, Hymns,

Music to be Played
 FINAL WISHES
FUNERAL & MEMORIAL SERVICE (Person 1, cont.)
MEMORIAL SERVICE DETAILS

Desired Flower
Arrangements

Photos/Keepsakes to
Set out During Funeral
or Reception

Charities to Donate to
in my Memory

Please Notify the Below

Groups/Organizations
of my Passing
Cost

Memorial Service
Guest List
(Include people your family
might not know to invite
and include their contact
information)

Auto Pay On?

 FINAL WISHES
PRE-ARRANGEMENTS MADE (Person 1)
Below, outline any of the above outlined arrangements that have already been formally arranged
with a funeral home or other company or service. Include copies of any formal paperwork,
documentation or receipts outlining arrangements in this section.

PRE-ARRANGEMENTS PAID FOR (Person 1)

Below, outline any of the above outlined arrangements or services that have already been paid for
regarding your final arrangements & service.
 FINAL WISHES
REPRESENTATIVE FOR FUNERAL ARRANGEMENTS (Person 2)

MEMORIAL SERVICE DETAILS

Person/People in charge of
Planning & Executing my
Final Wishes & Funeral

FINAL RESTING DETAILS (Person 2)

FINAL RESTING DETAILS
Desired Final
Resting State
(Buried, Cremated Donate to
Science, etc.)
Final Resting
Place Location
(Cemetery, Plot #, Spreading
Ashes, etc.)

Type of Casket/Urn to
Use
OPEN ☐ YES ☐
Open/Closed Casket? Embalmed?
CLOSED ☐ NO ☐
Wording to Put
on Headstone

Bury me with these

Keepsakes

Desired Clothes
to be Buried In
Funeral Home
to Use/Location/
Contact Info
Budget Set Aside for
Arrangements
Where to Find Official
Documents for
Pre-Arrangements
 FINAL WISHES
FUNERAL & MEMORIAL SERVICE (Person 2)
MEMORIAL SERVICE DETAILS
Describe the Type of
Service You Want
(Memorial Service, Graveside
Service, Service at Home, etc)

Any Other Funeral

Events Wanted?
(Viewing, Wake, Visitation, etc)
Cost
Memorial Service
Location
(Enter First & Second Choice)
Auto Pay On?

Memorial Service
Officiant
(Enter First & Second Choice)

Desired Pallbearers

Desired People to
Give Eulogy
Password
Points to Include
in Eulogy

Desired Readings,
Prayers, or Poems
to be Read

Above Readings to
be Given By

Desired Songs, Hymns,

Music to be Played
 FINAL WISHES
FUNERAL & MEMORIAL SERVICE (Person 2, cont.)
MEMORIAL SERVICE DETAILS

Desired Flower
Arrangements

Photos/Keepsakes to
Set out During Funeral
or Reception

Charities to Donate to
in my Memory

Please Notify the Below

Groups/Organizations
of my Passing
Cost

Memorial Service
Guest List
(Include people your family
might not know to invite
and include their contact
information)

Auto Pay On?

 FINAL WISHES
PRE-ARRANGEMENTS MADE (Person 2)
Below, outline any of the above outlined arrangements that have already been formally arranged
with a funeral home or other company or service. Include copies of any formal paperwork or
documentation outlining arrangements in this section.

PRE-ARRANGEMENTS PAID FOR (Person 2)

Below, outline any of the above outlined arrangements or services that have already been paid for
regarding your final arrangements & service.
assets
 ASSETS
“The rich buy assets. The poor only have expenses. The middle class buys
liabilities they think are assets. The poor and the middle-class work for money.
The rich have money work for them.” – Robert Kiyosaki

This section outlines all your ASSETS including:

• Bank Accounts
• Investments • Real Estate
• Retirement Accounts • All Motor Vehicles
• Other Valuables (Art, Jewelry, etc)
• Debts Owed to You

BANK ACCOUNTS
BANK ACOUNT #1
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

BANK ACOUNT #2
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook
 ASSETS
BANK ACCOUNTS
BANK ACOUNT #3
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

BANK ACOUNT #4
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

BANK ACOUNT #5
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

*If you have more than 5 bank accounts, print off this page again and fill out all the information for every bank
account you have.
 ASSETS
INVESTMENTS (Mutual Funds, Annuities, Stocks, etc)

INVESTMENT ACCOUNT #1
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #2
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #3
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #4
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information
 ASSETS
INVESTMENT ACCOUNT #5
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #6
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #7
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

INVESTMENT ACCOUNT #8
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information
*If you have more than 8 different investment accounts, print off this page again to document all your investments.
 ASSETS
RETIREMENT ACCOUNTS (401Ks, IRAs, Pensions etc)
RETIREMENT ACCOUNT #1
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #2
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #3
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #4
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information
 ASSETS
RETIREMENT ACCOUNT #5
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #6
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #7
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information

RETIREMENT ACCOUNT #8
Name on Account
Provider Name & Info Purchase Price
Account Type Account Number
Approx. Value As of
Beneficiary Information
Notes & Other Information
*If you have more than 8 retirement accounts, print off this page again to document all your investments.
 ASSETS
DEBTS OWED TO YOU
DEBT #1
Debtor Name
Debtor Contact Info
Original Loan Amount Loan Date
Interest Rate Monthly PMT
Current Balance As Of
Pay Off Date Payment Method

Other Details of Loan

DEBT #2
Debtor Name
Debtor Contact Info
Original Loan Amount Loan Date
Interest Rate Monthly PMT
Current Balance As Of
Pay Off Date Payment Method

Other Details of Loan

DEBT #3
Debtor Name
Debtor Contact Info
Original Loan Amount Loan Date
Interest Rate Monthly PMT
Current Balance As Of
Pay Off Date Payment Method

Other Details of Loan

 ASSETS
This part of the ASSET section will outline all your physical assets such as real estate, motor
vehicles and other valuables. If any of your assets currently have a lien against them, you will
enter in the lienholder and payoff information in the “Liabilities” section of the binder.

REAL ESTATE
PRIMARY RESIDENCE
Address
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Real Estate Agent
Contact Information

SECONDARY RESIDENCE
Address
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Real Estate Agent
Contact Information

TERTIARY RESIDENCE
Address
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Real Estate Agent
Contact Information
 ASSETS
INCOME PROPERTIES
INCOME PROPERTY #1
Address
Approx. Value As of
Paid Off? YES ☐ NO ☐
Estimated Equity in Home
Currently Rented Out? YES ☐ NO ☐ Monthly Rent
Renters Information
(Contact Info and Details
of Lease)

INCOME PROPERTY #2
Address
Approx. Value As of
Paid Off? YES ☐ NO ☐
Estimated Equity in Home
Currently Rented Out? YES ☐ NO ☐ Monthly Rent
Renters Information
(Contact Info and Details
of Lease)

INCOME PROPERTY #3
Address
Approx. Value As of
Paid Off? YES ☐ NO ☐
Estimated Equity in Home
Currently Rented Out? YES ☐ NO ☐ Monthly Rent
Renters Information
(Contact Info and Details
of Lease)
*If you have more than 3 income properties, reprint this page to include information about all your rental properties
 ASSETS
VEHICLES
VEHICLE #1
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Location of Spare Key License Plate #
VIN
VEHICLE #2
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Location of Spare Key License Plate #
VIN
VEHICLE #3
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
Location of Spare Key License Plate #
VIN
VEHICLE #4
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
VIN
*If you have more than 4 vehicles, print off this page again and fill out information for your remaining vehicles.
 ASSETS
OTHER MOTOR VEHICLES
MOTORCYCLE #1
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
VIN

MOTORCYCLE #2
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
VIN

BOAT
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
HIN

MOTOR HOME
Year/Make/Model
Date Purchased Purchase Price
Approx. Value As of
Paid Off? YES ☐ NO ☐ Estimated Equity
VIN
*If you have more assets that need to be listed, reprint this page and include information on all other vehicle motor vehicle assets.
 ASSETS
OTHER ASSETS & VALUABLES (Jewelry, Art, Collectibles, etc.)
*If you have insurance on any valuables, list the policy information in the “Insurance” section of the binder.
If these items are willed to anyone, list those details in the “Other Item Details” section.

ITEM #1
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #2
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #3
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #4
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details
 ASSETS
OTHER ASSETS & VALUABLES (Jewelry, Art, Collectibles, etc.)
ITEM #5
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #6
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #7
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details

ITEM #8
Item Name/Description
Model/Color/Serial #
Approx. Value As of
Insured? YES ☐ NO ☐ Item Location
Other Item Details
*If you have more physical assets & valuables that need to be outlined, print off this page again until you have all your assets documented.
liabilities
 LIABILITIES
“To succeed, you need to find something to hold on to, something to
motivate you, something to inspire you.” – Tony Dorsett

This section outlines all your LIABILITIES including:

• Credit Cards • Mortgage Debt
• Student Loans • Car & Motor Vehicle Loans
• Personal Loans • Loans from Family or Friends

SUMMARY
TOTAL LIABILITY SUMMARY
LIABILITY NAME LIABILITY AMOUNT

TOTAL
 LIABILITIES
CREDIT CARDS
CREDIT CARD #1
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

CREDIT CARD #2
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

CREDIT CARD #3
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

 LIABILITIES
CREDIT CARDS
CREDIT CARD #4
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

CREDIT CARD #5
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

CREDIT CARD #6
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

*If you have more than 6 credit cards, reprint this page and fill out the above information for each credit card you
have.
 LIABILITIES
STUDENT LOANS
STUDENT LOAN #1
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #2
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #3
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

 LIABILITIES
STUDENT LOANS
STUDENT LOAN #4
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #5
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #6
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

 LIABILITIES
STUDENT LOANS
STUDENT LOAN #7
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #8
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

STUDENT LOAN #9
Student Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

*If you have more than 9 student loans, reprint this page and fill out the above information for each of your student loans.
 LIABILITIES
PERSONAL LOANS
PERSONAL LOAN #1
Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

PERSONAL LOAN #2
Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

PERSONAL LOAN #3
Loan Name
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

*If you have more than 3 personal loans, reprint this page and fill out the above information for each of your personal loans.
 LIABILITIES
MORTGAGE DEBT
PRIMARY RESIDENCE LOAN
Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

SECONDARY RESIDENCE LOAN

Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

TERTIARY RESIDENCE LOAN

Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

 LIABILITIES
INCOME PROPERTY DEBT
INCOME PROPERTY LOAN #1
Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

INCOME PROPERTY LOAN #2

Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

INCOME PROPERTY LOAN #3

Name on Loans
Account Number
Lender Name Loan Type
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

 LIABILITIES
CAR LOANS
CAR LOAN #1
Vehicle (Make/Model)
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

CAR LOAN #2
Vehicle (Make/Model)
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

CAR LOAN #3
Vehicle (Make/Model)
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes

Auto Pay On? YES ☐ NO ☐
From:
 LIABILITIES
OTHER VEHICLE LOANS (Motorcycles, Motorhomes, Boats, etc)
VEHICLE LOAN #1
Make/Model
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

VEHICLE LOAN #2
Make/Model
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

VEHICLE LOAN #3
Make/Model
Name(s) on Loans
Account Number
Lender Name Interest Rate
Original Loan Amount Origination Date
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Account Payment Comes From: Auto Pay On? YES ☐ NO ☐

 LIABILITIES
LOANS OWED TO FAMILY & FRIENDS
FAMILY & FRIENDS LOAN #1
Money Owed To
Original Loan Amount Interest Rate
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Other Details & Terms of Loan Auto Pay On?

FAMILY & FRIENDS LOAN #2

Money Owed To
Original Loan Amount Interest Rate
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Other Details & Terms of Loan Auto Pay On?

FAMILY & FRIENDS LOAN #3

Money Owed To
Original Loan Amount Interest Rate
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Other Details & Terms of Loan Auto Pay On?

FAMILY & FRIENDS LOAN #4

Money Owed To
Original Loan Amount Interest Rate
Current Balance As Of
Monthly Due Date Minimum PMT
Extra Monthly Payment Amount Anticipated Payoff Date

Other Details & Terms of Loan Auto Pay On?

 bills &
accounts
 BILLS & ACCOUNTS
This section outlines all your other BILLS & ACCOUNTS
such as:
• Utilities • Subscriptions
• Phone, Cable & Internet • MISC Household Expenses
• Fitness Memberships • MISC Other Expenses

UTILITIES
ELECTRICITY
Name(s) on Account
Electricity Provider Account Number
Account Number
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

GAS
Name(s) on Account
Gas Provider Account Number
Account Number
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

WATER
Name(s) on Account
Water Provider Account Number
Account Number
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
PHONE, CABLE, INTERNET
CELL PHONE PLAN
Name(s) on Account
Cell Phone Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

CABLE
Name(s) on Account
Cable Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

INTERNET
Name(s) on Account
Internet Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

HOME PHONE/LANDLINE
Name(s) on Account
Phone Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
FITNESS MEMBERSHIPS
GYM MEMBERSHIP
Name(s) on Membership
Gym Name Account Number
Membership Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

OTHER FITNESS MEMBERSHIP #1

Name(s) on Membership
Gym Name Account Number
Membership Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

OTHER FITNESS MEMBERSHIP #2

Name(s) on Membership
Gym Name Account Number
Membership Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

OTHER FITNESS MEMBERSHIP #3

Name(s) on Membership
Gym Name Account Number
Membership Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
SUBSCRIPTIONS (Spotify, Netflix, Hulu, Box Subscriptions, etc)

SUBSCRIPTION #1
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #2
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #3
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #4
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
SUBSCRIPTIONS (Spotify, Netflix, Hulu, Box Subscriptions, etc)

SUBSCRIPTION #5
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #6
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #7
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

SUBSCRIPTION #8
Name(s) on Subscription
Subscription Service Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
MISC HOUSEHOLD EXPENSES
• Cleaning Service • Security System
• Lawn Service • Other Household Expenses

HOUSEHOLD EXPENSE #1
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

HOUSEHOLD EXPENSE #2
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

HOUSEHOLD EXPENSE #3
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

HOUSEHOLD EXPENSE #4
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

 BILLS & ACCOUNTS
OTHER MISC EXPENSES (Any re-occurring expense that does not fall into any of the above categories)
MISC EXPENSE #1
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

MISC EXPENSE #2
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

MISC EXPENSE #3
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

MISC EXPENSE #4
Expense Name
Service Provider Account Number
Account Number Monthly Due Date
Monthly Payment Amount Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Account Details:

insurance
 INSURANCE
In this section, outline all the details for each INSURANCE POLICY you hold in
the below categories:
• Property Insurance • Life Insurance
• Motor Vehicle Insurance • Pet Insurance
• Health Insurance • Valuables Insurance
• Disability Insurance • Other Insurance
•
PROPERTY INSURANCE
Outline the policy information for all your PROPERTY INSURANCE including:
• Homeowners Insurance • Flood Insurance
• Renters Insurance • Earthquake Insurance
• Fire Insurance • Farm Insurance

PROPERTY INSURANCE POLICY #1

Type of Insurance
Insurance Provider
Policy Number
Premium
Deductible
Amount of Coverage
Other Policy Details

PROPERTY INSURANCE POLICY #2

Type of Insurance
Insurance Provider
Policy Number
Premium
Deductible
Amount of Coverage
Other Policy Details
 INSURANCE
PROPERTY INSURANCE
PROPERTY INSURANCE POLICY #3
Type of Insurance
Insurance Provider
Policy Number
Premium
Deductible
Amount of Coverage
Other Policy Details

PROPERTY INSURANCE POLICY #4

Type of Insurance
Insurance Provider
Policy Number
Premium
Deductible
Amount of Coverage
Other Policy Details

PROPERTY INSURANCE POLICY #5

Type of Insurance
Insurance Provider
Policy Number
Premium
Deductible
Amount of Coverage
Other Policy Details
 INSURANCE
MOTOR VEHICLE INSURANCE
Outline the policy information for all your MOTOR VEHICLE INSURANCE including:
• Car Insurance • Caravan Insurance
• Boat Insurance • Motorcycle Insurance

MOTOR VEHICLE INSURANCE POLICY #1

Type of Insurance
Insurance Provider
Vehicle Covered
Drivers Covered
Policy Number
Premium
Deductible
Other Policy Details

MOTOR VEHICLE INSURANCE POLICY #2

Type of Insurance
Insurance Provider
Vehicle Covered
Drivers Covered
Policy Number
Premium
Deductible
Other Policy Details
 INSURANCE
MOTOR VEHICLE INSURANCE
MOTOR VEHICLE INSURANCE POLICY #3
Type of Insurance
Insurance Provider
Vehicle Covered
Drivers Covered
Policy Number
Premium Deductible
Other Policy Details

MOTOR VEHICLE INSURANCE POLICY #4

Type of Insurance
Insurance Provider
Vehicle Covered
Drivers Covered
Policy Number
Premium Deductible
Other Policy Details

MOTOR VEHICLE INSURANCE POLICY #5

Type of Insurance
Insurance Provider
Vehicle Covered
Drivers Covered
Policy Number
Premium Deductible
Other Policy Details
 INSURANCE
HEALTH INSURANCE
Outline the policy information for all your HEALTH INSURANCE including:
• Medical Insurance • Vision Insurance
• Dental Insurance • Long-Term Care Insurance

HEALTH INSURANCE POLICY #1

Who is Covered?
Type of Insurance
Insurance Provider Policy Type (PPO, HDHP)

Group Number Policy Number

Co-Pay Amount Monthly Premium
How is Premium Paid? Auto Pay On? YES ☐ NO ☐
Other Details of Location of Checkbook
Coverage & Policy

HEALTH INSURANCE POLICY #2

Who is Covered?
Type of Insurance
Insurance Provider Policy Type (PPO, HDHP)

Group Number Policy Number

Co-Pay Amount Monthly Premium
How is Premium Paid? Auto Pay On? YES ☐ NO ☐
Other Details of Location of Checkbook
Coverage & Policy
 INSURANCE
HEALTH INSURANCE
HEALTH INSURANCE POLICY #3
Who is Covered?
Type of Insurance
Insurance Provider Policy Type (PPO, HDHP)

Group Number Policy Number

Co-Pay Amount Monthly Premium
How is Premium Paid? Auto Pay On? YES ☐ NO ☐
Other Details of Location of Checkbook
Coverage & Policy

HEALTH INSURANCE POLICY #4

Who is Covered?
Type of Insurance
Insurance Provider Policy Type (PPO, HDHP)

Group Number Policy Number

Co-Pay Amount Monthly Premium
How is Premium Paid? Auto Pay On? YES ☐ NO ☐
Other Details of Location of Checkbook
Coverage & Policy

HEALTH INSURANCE POLICY #5

Who is Covered?
Type of Insurance
Insurance Provider Policy Type (PPO, HDHP)

Group Number Policy Number

Co-Pay Amount Monthly Premium
How is Premium Paid? Auto Pay On? YES ☐ NO ☐
Other Details of Location of Checkbook
Coverage & Policy
 INSURANCE
DISABILITY INSURANCE
Outline the policy information for all your DISABILITY INSURANCE including:
• Short-Term Disability • Long-Term Disability

DISABILITY INSURANCE POLICY #1

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details

DISABILITY INSURANCE POLICY #2

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details

DISABILITY INSURANCE POLICY #3

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details
 INSURANCE
LIFE INSURANCE
Outline the policy information for all your LIFE INSURANCE including:
• Term/Whole Life Insurance • AD&D Insurance

LIFE INSURANCE POLICY #1

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details

LIFE INSURANCE POLICY #2

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details

LIFE INSURANCE POLICY #3

Type of Insurance
Who is Covered?
Insurance Provider
Policy Number
Premium
Amount of Coverage
Other Policy Details
 INSURANCE
LIFE INSURANCE
Below, outline your wishes for any Life Insurance pay-outs that will occur as a result of your death.

Who is the BENEFICIARY of your LIFE INSRUANCE POLICIES?

LIFE INSURANCE POLICY BENFICIARIES
Policy #1 Beneficiary
Policy #2 Beneficiary
Policy #3 Beneficiary
Policy #4 Beneficiary

Do you want the above beneficiaries to distribute/share the LIFE INSURANCE FUNDS in
any way to other people (i.e. other family members, friends, charities, etc)?
LIFE INSURANCE POLICY BENFICIARIES
Policy #1 Instructions

Policy #2 Instructions

Policy #3 Instructions

Policy #4 Instructions

What do you want your LIFE INSURANCE money to be used for? For instance, paying off
debts, saving for a college fund, paying off your home, a trip for your family, etc.
LIFE INSURANCE POLICY BENFICIARIES
Policy #1 Instructions

Policy #2 Instructions

Policy #3 Instructions

Policy #4 Instructions
 INSURANCE
PET INSURANCE
If you have insurance policies that cover your pets, enter the policy information
below for each pet. If you have more than 3 pets that are covered, reprint this
page so the policy information for each pet is covered.

PET INSURANCE POLICY #1

Pet Covered
Insurance Provider
Policy Number
Monthly Premium
Services Covered
Other Policy Details

PET INSURANCE POLICY #2

Pet Covered
Insurance Provider
Policy Number
Monthly Premium
Services Covered
Other Policy Details

PET INSURANCE POLICY #3

Pet Covered
Insurance Provider
Policy Number
Monthly Premium
Services Covered
Other Policy Details
 INSURANCE
VALUABLES INSURANCE
Outline the policy information for any VALUABLES INSURANCE that cover items
such as:
• Jewelry • Antiques
• Fine Art • Collectibles

VALUABLES INSURANCE POLICY #1

Item Covered
Insurance Provider
Policy Number
Monthly Premium
Deductible
Other Policy Details

VALUABLES INSURANCE POLICY #2

Item Covered
Insurance Provider
Policy Number
Monthly Premium
Deductible
Other Policy Details

VALUABLES INSURANCE POLICY #3

Item Covered
Insurance Provider
Policy Number
Monthly Premium
Deductible
Other Policy Details
 INSURANCE
VALUABLES INSURANCE
VALUABLES INSURANCE POLICY #4
Item Covered
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details

VALUABLES INSURANCE POLICY #5

Item Covered
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details

VALUABLES INSURANCE POLICY #6

Item Covered
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details

VALUABLES INSURANCE POLICY #7

Item Covered
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details
 INSURANCE
OTHER INSURANCE
Outline the policy information for any type of OTHER INSURANCE you have. Some
examples include:
• Workers Compensation • Mortgage Protection Insurance
• Unemployment Insurance • Business Insurance

OTHER INSURANCE POLICY #1

Type of Insurance
Who/What Covered?
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details

OTHER INSURANCE POLICY #2

Type of Insurance
Who/What Covered?
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details

OTHER INSURANCE POLICY #3

Type of Insurance
Who/What Covered?
Insurance Provider
Policy Number
Monthly Premium Deductible
Other Policy Details
monthly
budget
 MONTHLY BUDGET
This section is to outline your MONTHLY BUDGET including your income and expenses.

BUDGET SOFTWARE
If you use a budgeting software like Mint, YNAB, or Every Dollar document
your account and login information below.

BUDGET SOFTWARE INFORMATION

Name of Software
Paid or Free? Cost
Monthly/Annual Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From:

Login URL:
Username Password

INCOME SOURCES
Below, outline your sources and frequency of income.
INCOME SOURCE #1
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:
If DD, list Bank Account
Password
Deposited To:

INCOME SOURCE #2
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:
If DD, list Bank Account
Password
Deposited To:
 MONTHLY BUDGET
INCOME SOURCES
INCOME SOURCE #3
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:
If DD, list Bank Account
Password
Deposited To:

INCOME SOURCE #4
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:

INCOME SOURCE #5
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:
If DD, list Bank Account
Password
Deposited To:

INCOME SOURCE #6
Name of Income Source
Income Frequency Cost
Average Amount Per Pay Period
How is Income Received? CASH ☐ CHECK ☐ DIRECT DEPOSIT ☐ OTHER ☐
If OTHER, specify:
If DD, list Bank Account
Password
Deposited To:
 MONTHLY BUDGET
MONTHLY BUDGET OVERVIEW
Below, provide an overview of your monthly budget or feel free to include your own version and
copy of your monthly budget. Note: The cells below are mostly left blank so it can be most
customizable to your unique budget. Only a few examples are given. Fill in the rest of the cells
with your own unique bills, expenses, and monthly contributions towards financial goals.
INCOME
Estimated Total Monthly Income

MONTHLY BILLS
Bill Name Amount Bill Name Amount
Mortgage/Rent Car Insurance

OTHER MONTHLY EXPENSES

Expense Name Amount Expense Name Amount
Food Clothing

FINANCIAL GOALS
Financial Goal Monthly Amount
Monthly Savings Goal
Extra Monthly Amount Paid Towards Debt
 MONTHLY BUDGET
MONTHLY BUDGET DETAILS & INSTRUCTIONS
Below, document any detailed instructions or nuances regarding your budget that should be
noted such as irregular expenses, sinking funds, cash envelopes, etc.
household
items
 HOUSEHOLD ITEMS
This section is to outline important information about your HOUSEHOLD like:
• Household Taxes • Household Favorites
• Household Schedule • Household Passwords
• Household Service Providers • Household Final Wishes

Note: If you have more than one residence, you can print this section
off again and fill out for all your additional residences.

HOUSEHOLD TAXES
HOUSEHOLD TAX DETAILS
Total Household Annual Tax
Winter Tax Amount
Summer Tax Amount
Are Taxes Paid From Escrow? YES ☐ NO ☐
If yes, list Escrow Account Info
If no, how are taxes Paid?
Where to Find Tax Documents

HOUSEHOLD SCHEDULE
HOUSEHOLD SCHEDULE DETAILS
Thermostat Temperature
Day of Trash Pick-Up
Day of Recycling Pick-Up
How Often to Mow Lawn?
How Often to Water Lawn?

Other Lawn Care Details

Household Cleaning Day
Household Laundry Day
How Often to Clean
Carpets/Floors?
How Often to Clean Windows?
How Often to Change Air Filters?

Other Seasonal Up-Keep Items

 HOUSEHOLD ITEMS
HOUSEHOLD SERVICE PROVIDERS
HOUSEHOLD REALTOR
Name of Realtor
Address Breed
Phone/Email
Realtor Schedule
What did this Realtor help
you with?

HOUSEHOLD CLEANING SERVICE

Cleaning Service Name
Address Breed
Phone/Email
Cost
Cleaning Service Schedule
Any Special Instructions
for Cleaning Service

HOUSEHOLD CARPET/FLOOR/RUG CLEANING SERVICE

Cleaning Service Name
Address Breed
Phone/Email
Cost
Cleaning Service Schedule
Any Special Instructions
for Cleaning Service
 HOUSEHOLD ITEMS
HOUSEHOLD SERVICE PROVIDERS
HOUSEHOLD LANDSCAPING SERVICE
Landscaper Name
Address Breed
Phone/Email
Cost
Landscaper Schedule
Any Special Instructions
for Landscaper

HOUSEHOLD SNOW REMOVAL SERVICE

Name of Company
Address Breed
Phone/Email
Cost
Snow Removal Schedule
Any Special Instructions
for Snow Removal

HOUSEHOLD SECURITY SYSTEM PROVIDER

Security Company Name
Address Breed
Phone/Email
Cost
Any Special Instructions
for Security System
 HOUSEHOLD ITEMS
HOUSEHOLD SERVICE PROVIDERS
HOUSEHOLD HANDYMAN
Handyman Name
Address Breed
Phone/Email
Cost
Handyman Schedule
Any Special Instructions
for Handyman

HOUSEHOLD ELECTRICIAN
Electrician Name
Address Breed
Phone/Email
Cost
Electrician Schedule
Any Special Instructions
for Electrician

HOUSEHOLD PLUMBER
Name of Plumber
Address Breed
Phone/Email
Cost
Plumber Schedule
Any Special Instructions
for Plumber
 HOUSEHOLD ITEMS
HOUSEHOLD SERVICE PROVIDERS
OTHER HOUSEHOLD SERVICE PROVIDER #1
Service Provider Name
Address Breed
Phone/Email
Cost
Service Provider Schedule
Any Special Instructions
for Service Provider

OTHER HOUSEHOLD SERVICE PROVIDER #2

Service Provider Name
Address Breed
Phone/Email
Cost
Service Provider Schedule
Any Special Instructions
for Service Provider

OTHER HOUSEHOLD SERVICE PROVIDER #3

Service Provider Name
Address Breed
Phone/Email
Cost
Service Provider Schedule
Any Special Instructions
for Service Provider
 HOUSEHOLD ITEMS
HOUSEHOLD FAVORITES
LIST OF HOUSEHOLD FAVORITES

Favorite Brands of Foods

Favorite Brands of
Cleaning Supplies

Breed
Favorite Brands of
Laundry Supplies
Favorite Brands of
Dish Washing Supplies
Favorite Brand of Appliances
Favorite Brand of Toilet Paper
Favorite Brand of Paper Towels
Favorite Brand of
Shampoo/Conditioner/Soap
Favorite Brand of Towels
Favorite Brand of Bed Sheets
 HOUSEHOLD ITEMS
HOUSEHOLD FAVORITES: RECIPES
Below, write out your favorite recipes, or leave copies of your favorite recipes in
this section that your loved ones can continue making after your gone.
 HOUSEHOLD ITEMS
HOUSEHOLD PASSWORDS
Below, outline password instructions specific to your home. Passwords for electronics, storage
units, safes, etc. will be outlined in the “Logins & Passwords” Section.

HOUSEHOLD PASSWORDS
Household Item Password Instructions
Gate Password
Garage Door Password Breed
Front Door Lock Password
Security Alarm Code

Below, write out any detailed instructions needed to access secured or locked
areas of your home or property that are not covered above.
 HOUSEHOLD ITEMS
HOUSEHOLD FINAL WISHES
Below, outline instructions for what you want to happen to your home in the event of your death
or you and your spouse’s death. The contents inside your home should be outlined in the “Estate
Planning” section, so more so focus on who you want the house to go to, sell vs not sell, etc.

DISCLAIMER: This is simply a summary of your wishes and in no way is the information in this section
legally binding. You are advised to have the details below stated in your will & estate plan documents.
children
 CHILDREN
This section is to outline important information about your CHILDREN like:
• Personal Information • Child Service Providers
• Medical Information • School Information
• Schedule Information • Child Favorites

PERSONAL INFORMATION
CHILD #1
Child Name
Gender DOB
Birth City, State Birth Hospital
Birth Weight/Height SSN

CHILD #2
Child Name
Gender DOB
Birth City, State Birth Hospital
Birth Weight/Height SSN

CHILD #3
Child Name
Gender DOB
Birth City, State Birth Hospital
Birth Weight/Height SSN

CHILD #4
Child Name
Gender DOB
Birth City, State Birth Hospital
Birth Weight/Height SSN
 CHILDREN
MEDICAL INFORMATION
CHILD #1
Child Name
Primary Care Physician Breed
Physician Contact Info Email
Child Allergies
Child Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of

CHILD #2
Child Name
Primary Care Physician Breed
Physician Contact Info Email
Child Allergies
Child Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of
 CHILDREN
MEDICAL INFORMATION
CHILD #3
Child Name
Primary Care Physician Breed
Physician Contact Info Email
Child Allergies
Child Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of

CHILD #4
Child Name
Primary Care Physician Breed
Physician Contact Info Email
Child Allergies
Child Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of
 CHILDREN
SCHEDULE INFORMATION
CHILD #1
Child Name
Meal Schedule/Times
Wake Up Time Bed Time
Nap Times Curfew
Activity #1
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #2
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #3
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #4
Name of Activity/Club
Primary Contact Name &
Phone Number
Activity Commitment
Schedule Details
 CHILDREN
SCHEDULE INFORMATION
CHILD #2
Child Name
Meal Schedule/Times
Wake Up Time Bed Time
Nap Times Curfew
Activity #1
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #2
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #3
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #4
Name of Activity/Club
Primary Contact Name &
Phone Number
Activity Commitment
Schedule Details
 CHILDREN
SCHEDULE INFORMATION
CHILD #3
Child Name
Meal Schedule/Times
Wake Up Time Bed Time
Nap Times Curfew
Activity #1
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #2
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #3
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #4
Name of Activity/Club
Primary Contact Name &
Phone Number
Activity Commitment
Schedule Details
 CHILDREN
SCHEDULE INFORMATION
CHILD #4
Child Name
Meal Schedule/Times
Wake Up Time Bed Time
Nap Times Curfew
Activity #1
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #2
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #3
Name of Activity/Club
Primary Contact Name &
Phone Number

Activity Commitment
Schedule Details

Activity #4
Name of Activity/Club
Primary Contact Name &
Phone Number
Activity Commitment
Schedule Details
 CHILDREN
CHILD SERVICE PROVIDERS
CHILD DAY-CARE
Name of Day-Care
Address Breed
Phone/Email
Cost
Day-Care Schedule
Any Special Instructions
for Day-Care

CHILD BABYSITTER
Babysitter Name
Address Breed
Phone/Email
Cost
Babysitter Schedule
Any Special Instructions
for Babysitter

CHILD DENTIST
Dentist Name
Address Breed
Phone/Email
Last Cleaning Date
Dentist Schedule
Any Special Instructions
for Dentist
 CHILDREN
CHILD SERVICE PROVIDERS
CHILD DOCTOR #1
Name of Doctor
Address Breed
Phone/Email
Type of Doctor
Visit/Care Schedule
Any Special Instructions
for Doctor

CHILD DOCTOR #2
Name of Doctor
Address Breed
Phone/Email
Type of Doctor
Visit/Care Schedule
Any Special Instructions
for Doctor

CHILD HAIRCUTS
Stylist Name
Address Breed
Phone/Email
Last Hair Cut
Stylist Schedule
Any Special Instructions
for Stylist
 CHILDREN
CHILD SERVICE PROVIDERS
OTHER CHILD SERVICE PROVIDER #1
Name of Provider
Address Breed
Phone/Email
Service Provided
Visit/Care Schedule
Any Special Instructions
for Provider

OTHER CHILD SERVICE PROVIDER #2

Name of Provider
Address Breed
Phone/Email
Service Provided
Visit/Care Schedule
Any Special Instructions
for Provider

OTHER CHILD SERVICE PROVIDER #3

Name of Provider
Address Breed
Phone/Email
Service Provided
Visit/Care Schedule
Any Special Instructions
for Provider
 CHILDREN
SCHOOL INFORMATION
CHILD #1
Child Name
School Name Breed
School Address
School Start Time School End Time
Child Current Grade Child Teacher Name
Child Teacher Contact
Information
Bring Lunch/
Buy Lunch?
Transportation Details
To/From School

List of School
Activities/Involvement

CHILD #2
Child Name
School Name Breed
School Address
School Start Time School End Time
Child Current Grade Child Teacher Name
Child Teacher Contact
Information
Bring Lunch/
Buy Lunch?
Transportation Details
To/From School

List of School
Activities/Involvement
 CHILDREN
SCHOOL INFORMATION
CHILD #3
Child Name
School Name Breed
School Address
School Start Time School End Time
Child Current Grade Child Teacher Name
Child Teacher Contact
Information
Bring Lunch/
Buy Lunch?
Transportation Details
To/From School

List of School
Activities/Involvement

CHILD #4
Child Name
School Name Breed
School Address
School Start Time School End Time
Child Current Grade Child Teacher Name
Child Teacher Contact
Information
Bring Lunch/
Buy Lunch?
Transportation Details
To/From School

List of School
Activities/Involvement
 CHILDREN
CHILD FAVORITES
Below, list your child’s favorite things!
CHILD #1
Child Name
Favorite Snack(s)
Favorite Meal(s)
Favorite Treat(s)
Favorite Drink(s)
Favorite Toy(s) Breed
Favorite Stuffed Animal(s)
Favorite Book(s)
Favorite Song(s)
Favorite Movies(s) School End Time
Favorite Character(s)
Favorite Place(s)
Favorite Game(s)
Favorite Sports(s) Child Teacher Name
Favorite Sports Team(s)
Favorite Animal(s)
Favorite Friend(s)
Favorite Family Member(s)
Favorite Color(s)
Favorite Outfit(s)

Document any other special details about your child that you feel would
provide peace and comfort in your passing.
 CHILDREN
CHILD FAVORITES
Below, list your child’s favorite things!
CHILD #2
Child Name
Favorite Snack(s)
Favorite Meal(s)
Favorite Treat(s)
Favorite Drink(s)
Favorite Toy(s) Breed
Favorite Stuffed Animal(s)
Favorite Book(s)
Favorite Song(s)
Favorite Movies(s) School End Time
Favorite Character(s)
Favorite Place(s)
Favorite Game(s)
Favorite Sports(s) Child Teacher Name
Favorite Sports Team(s)
Favorite Animal(s)
Favorite Friend(s)
Favorite Family Member(s)
Favorite Color(s)
Favorite Outfit(s)

Document any other special details about your child that you feel would
provide peace and comfort in your passing.
 CHILDREN
CHILD FAVORITES
Below, list your child’s favorite things!
CHILD #3
Child Name
Favorite Snack(s)
Favorite Meal(s)
Favorite Treat(s)
Favorite Drink(s)
Favorite Toy(s) Breed
Favorite Stuffed Animal(s)
Favorite Book(s)
Favorite Song(s)
Favorite Movies(s) School End Time
Favorite Character(s)
Favorite Place(s)
Favorite Game(s)
Favorite Sports(s) Child Teacher Name
Favorite Sports Team(s)
Favorite Animal(s)
Favorite Friend(s)
Favorite Family Member(s)
Favorite Color(s)
Favorite Outfit(s)

Document any other special details about your child that you feel would
provide peace and comfort in your passing.
 CHILDREN
CHILD FAVORITES
Below, list your child’s favorite things!
CHILD #4
Child Name
Favorite Snack(s)
Favorite Meal(s)
Favorite Treat(s)
Favorite Drink(s)
Favorite Toy(s) Breed
Favorite Stuffed Animal(s)
Favorite Book(s)
Favorite Song(s)
Favorite Movies(s) School End Time
Favorite Character(s)
Favorite Place(s)
Favorite Game(s)
Favorite Sports(s) Child Teacher Name
Favorite Sports Team(s)
Favorite Animal(s)
Favorite Friend(s)
Favorite Family Member(s)
Favorite Color(s)
Favorite Outfit(s)

Document any other special details about your child that you feel would
provide peace and comfort in your passing.
pets
 PETS
This section is to outline important information about your PETS such as:
• Personal Information • Pet Service Providers
• Medical Information • Pet Favorites
• Care & Schedule Information • After Death Instructions

PERSONAL INFORMATION
PET #1
Pet Name
Gender Breed
Registration Tag # Spayed/Neutered? YES ☐ NO ☐
Chipped? YES ☐ NO ☐ Chip Number

PET #2
Pet Name
Gender Breed
Registration Tag # Spayed/Neutered? YES ☐ NO ☐
Chipped? YES ☐ NO ☐ Chip Number

PET #3
Pet Name
Gender Breed
Registration Tag # Spayed/Neutered? YES ☐ NO ☐
Chipped? YES ☐ NO ☐ Chip Number

PET #4
Pet Name
Gender Breed
Registration Tag # Spayed/Neutered? YES ☐ NO ☐
Chipped? YES ☐ NO ☐ Chip Number
 PETS
MEDICAL INFORMATION
PET #1
Pet Name
Vet Name & Address Breed
Vet Phone Number Email
Pet Allergies
Pet Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of

PET #2
Pet Name
Vet Name & Address Breed
Vet Phone Number Email
Pet Allergies
Pet Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of
 PETS
MEDICAL INFORMATION
PET #3
Pet Name
Vet Name & Address Breed
Vet Phone Number Email
Pet Allergies
Pet Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of

PET #4
Pet Name
Vet Name & Address Breed
Vet Phone Number Email
Pet Allergies
Pet Medication Name(s)
Medication Frequency
How to Administer
Medication Cost
Rx Pick Up Information
Latest Immunization
Record Location

Other Medical Issues to Be

Aware Of
 PETS
CARE & SCHEDULE INFORMATION
PET #1
Pet Name
Food Brand Breed
Meal Schedule
Meal Portions
Pet Walking Schedule
Grooming/Bath Schedule
Sleep Schedule/Location

Location of Leashes/Toys/
Crates/Grooming Tools

Pet Anxieties (Storms,

Separation, etc.)

PET #2
Pet Name
Food Brand Breed
Meal Schedule
Meal Portions
Pet Walking Schedule
Grooming/Bath Schedule
Sleep Schedule/Location

Location of Leashes/Toys/
Crates/Grooming Tools

Pet Anxieties (Storms,

Separation, etc.)
 PETS
CARE & SCHEDULE INFORMATION
PET #3
Pet Name
Food Brand Breed
Meal Schedule
Meal Portions
Pet Walking Schedule
Grooming/Bath Schedule
Sleep Schedule/Location

Location of Leashes/Toys/
Crates/Grooming Tools

Pet Anxieties (Storms,

Separation, etc.)

PET #4
Pet Name
Food Brand Breed
Meal Schedule
Meal Portions
Pet Walking Schedule
Grooming/Bath Schedule
Sleep Schedule/Location

Location of Leashes/Toys/
Crates/Grooming Tools

Pet Anxieties (Storms,

Separation, etc.)
 PETS
PET SERVICE PROVIDERS
PET DAY CARE
Name
Address Breed
Phone/Email
Cost
Pet Day Care Schedule

Any Special Instructions

for Pet Day Care

PET BOARDING
Name
Address Breed
Phone/Email
Cost
Pet Boarding Schedule

Any Special Instructions

for Pet Boarding

PET GROOMING
Name
Address Breed
Phone/Email
Cost
Pet Grooming Schedule

Any Special Instructions

for Pet Grooming
 PETS
PET SERVICE PROVIDERS
PET SITTER
Name
Address Breed
Phone/Email
Cost
Pet Sitter Schedule

Any Special Instructions

for Pet Sitter

PET WALKER
Name
Address Breed
Phone/Email
Cost
Pet Walker Schedule

Any Special Instructions

for Pet Walker

PET TRAINER
Name
Address Breed
Phone/Email
Cost
Pet Trainer Schedule

Any Special Instructions

for Pet Trainer
 PETS
PET FAVORITES
PET #1
Pet Name
Favorite Treats
Favorite Toys Breed
Favorite Games
Favorite Tricks
Favorite People
Favorite Other Animals
Favorite Places & Parks

PET #2
Pet Name
Favorite Treats
Favorite Toys Breed
Favorite Games
Favorite Tricks
Favorite People
Favorite Other Animals
Favorite Places & Parks

PET #3
Pet Name
Favorite Treats
Favorite Toys Breed
Favorite Games
Favorite Tricks
Favorite People
Favorite Other Animals
Favorite Places & Parks
 PETS
PET FAVORITES
PET #4
Pet Name
Favorite Treats
Favorite Toys Breed
Favorite Games
Favorite Tricks
Favorite People
Favorite Other Animals
Favorite Places & Parks

AFTER DEATH INSTRUCTIONS

Below, please outline specific instructions for your pet’s care & guardianship in the event
of your death. Most importantly, who will be caring for them in your absence.
 medical
information
 MEDICAL INFORMATION
This section is to outline your relevant MEDICAL INFORMATION including:
• General Medical Information • Family Medical History
• Doctors • Allergies
• Prescriptions • Previous Surgeries
• Illnesses/Disorders • FSA & HSA Accounts

GENERAL MEDICAL INFORMATION (Person 1)

GENERAL MEDICAL INFORMATION
Full Name
Age Ethnicity
Weight Height
Blood Type Organ Donor? YES ☐ NO ☐

DOCTORS (Person 1)
PRIMARY PHYSICIAN
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

DENTIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OPHTHALMOLOGISTS
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
DOCTORS (Person 1)
DERMATOLOGIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

CARDIOLOGIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OBGYN
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

CHIROPRACTOR
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

PSYCHIATRIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
DOCTORS (Person 1)
OTHER DOCTOR #1
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #2
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #3
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #4
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
PERSCRIPTIONS (Person 1)
PHARMACY INFORMATION
Pharmacy Name
Pharmacy Location
Pharmacy Phone Number As Of

PERSCRIPTION #1
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐

PERSCRIPTION #2
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐

PERSCRIPTION #3
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐
*If you have more than 3 prescriptions, print off this page again and fill out
the above information for each of your prescriptions.
 MEDICAL INFORMATION
ILLNESSES & DISORDERS (Person 1)
ILLNESS OR DISORDER #1
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #2
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #3
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #4
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder
 MEDICAL INFORMATION
FAMILY MEDICAL HISTORY (Person 1)
FAMILY HISTORY #1
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #2
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #3
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #4
Who
Relationship
Illness/Disorder

Details
 MEDICAL INFORMATION
ALLERGIES (Person 1)
Below, please write all your allergies.

ALLERGIES

PREVIOUS SURGERIES (Person 1)

PREVIOUS SURGERIES #1
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

PREVIOUS SURGERIES #2
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

PREVIOUS SURGERIES #3
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

 MEDICAL INFORMATION
FSA & HSA ACCOUNTS (Person 1)
FLEXIBLE SPENDING ACCOUNT (FSA) #1
FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

FLEXIBLE SPENDING ACCOUNT (FSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

HEALTH SPENDING ACCOUNT (HSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

HEALTH SPENDING ACCOUNT (HSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location
 MEDICAL INFORMATION
This section is the same MEDICAL INFORMATION from above, but for your
spouse. If you are single, then you can move onto the next section.

GENERAL MEDICAL INFORMATION (Person 2)

GENERAL MEDICAL INFORMATION
Full Name
Age Ethnicity
Weight Height
Blood Type Organ Donor? YES ☐ NO ☐

DOCTORS (Person 2)
PRIMARY PHYSICIAN
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

DENTIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OPHTHALMOLOGISTS
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
DOCTORS (Person 2)
DERMATOLOGIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

CARDIOLOGIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OBGYN
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

CHIROPRACTOR
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

PSYCHIATRIST
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
DOCTORS (Person 2)
OTHER DOCTOR #1
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #2
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #3
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐

OTHER DOCTOR #4
Doctor Type
Doctor Name
Office Location Ethnicity
Doctor Contact Information Height
Seen Since Insurance Accepted? YES ☐ NO ☐
 MEDICAL INFORMATION
PERSCRIPTIONS (Person 2)
PHARMACY INFORMATION
Pharmacy Name
Pharmacy Location
Pharmacy Phone Number As Of

PERSCRIPTION #1
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐

PERSCRIPTION #2
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐

PERSCRIPTION #3
Prescription Name
Rx Schedule/Rules
Prescribing Doctor
Rx Number Dosage
Pills Per Refill Refill Cost?
Auto Fill? YES ☐ NO ☐ Covered by Insurance? YES ☐ NO ☐
*If you have more than 3 prescriptions, print off this page again and fill out
the above information for each of your prescriptions.
 MEDICAL INFORMATION
ILLNESSES & DISORDERS (Person 2)
ILLNESS OR DISORDER #1
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #2
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #3
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder

ILLNESS OR DISORDER #4
Illness/Disorder Name
Diagnosis Date
Doctor for Illness/Disorder
Treatment Facility Location
Rx for Illness/Disorder
 MEDICAL INFORMATION
FAMILY MEDICAL HISTORY (Person 2)
FAMILY HISTORY #1
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #2
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #3
Who
Relationship
Illness/Disorder

Details

FAMILY HISTORY #4
Who
Relationship
Illness/Disorder

Details
 MEDICAL INFORMATION
ALLERGIES (Person 2)
Below, please write all your allergies.

ALLERGIES

PREVIOUS SURGERIES (Person 2)

PREVIOUS SURGERIES #1
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

PREVIOUS SURGERIES #2
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

PREVIOUS SURGERIES #3
Surgery Description
Hospital of Surgery
Name of Surgeon
Date of Surgery

Other Surgery Details

 MEDICAL INFORMATION
FSA & HSA ACCOUNTS (Person 2)
FLEXIBLE SPENDING ACCOUNT (FSA) #1
FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

FLEXIBLE SPENDING ACCOUNT (FSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

HEALTH SPENDING ACCOUNT (HSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location

HEALTH SPENDING ACCOUNT (HSA) #2

FSA Provider
FSA Account Number
FSA Balance As Of
FSA Debit Card Number
Card Expiration Date Card CSV Number
Card Location
 business
information
 BUSINESS INFORMATION
This section is to outline information about your PRIVATE BUSINESS
including:
• General Business Information • Business Service Providers
• Employees • Business Logins & Passwords
• Business Financial Information • Business After-Death Wishes

GENERAL BUSINESS INFORMATION

GENERAL BUSINESS INFORMATION
Name of Business
Address of Business
Business Phone Number Business Email
Date Founded EIN
Your Position in Company Fiscal Year End
Business Structure
(LLC, Sole Proprietorship, etc.)

Partner Name Partner Stake

Partner Contact Information

EMPLOYEES
Employee #1
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay

Employee #2
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay
 BUSINESS INFORMATION
EMPLOYEES
Employee #3
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay

Employee #4
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay

Employee #5
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay

Employee #6
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay

Employee #7
Employee Name
Employee Title/Position
Employee Phone Number Employee Email
Employed Since Current Pay
*If you have more than 7 employees for your business, re-print this page and fill out the
above until you have all your employees listed.
 BUSINESS INFORMATION
BUSINESS BANK ACCOUNTS
BUSINESS BANK ACOUNT #1
Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

BUSINESS BANK ACOUNT #2

Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook

BUSINESS BANK ACOUNT #3

Name(s) on Accounts
Type of Account Bank Name
Bank Contact Information
Account Number Routing Number
Debit Card Number Card PIN
Card Expiration Date Card CVV
Debit Card PIN Number Location of Checkbook
BUSINESS INFORMATION
BUSINESS CREDIT CARDS
BUSINESS CREDIT CARD #1
Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

BUSINESS CREDIT CARD #2

Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

BUSINESS CREDIT CARD #3

Name(s) on Card Account
Type (Visa, AMEX, etc) Issuing Bank
Card Number
Card Expiration Date Card CVV
Balance As Of
Monthly Due Date Auto Pay On? YES ☐ NO ☐
Account Payment is Made From: Location of Checkbook

Other Card Details/Information:

BUSINESS INFORMATION
BUSINESS TAXES
BUSINESS TAX INFORMATION
Business Tax
Accountant Name
Business Tax
Issuing Bank
Accountant Address

Business Tax
Accountant Contact Info

List the Different Types

of Taxes you Pay For
Your Business and Card CVV
Approx. Rates
(i.e. State Income Tax, Payroll
Tax, Property Tax, etc)

Where to Find Copies of

As Of
Past Tax Returns

Below, detail any specific tax instructions that are unique to your business that are important to note.
BUSINESS INFORMATION
BUSINESS SERVICE PROVIDERS
Below, outline information for companies, partners or services that you work with that help you run and
support your business like accounting software, advisors, lawyers, website hosting & design, etc.

BUSINESS SERVICE PROVIDER #1

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #2

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #3

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider
BUSINESS INFORMATION
BUSINESS SERVICE PROVIDERS

BUSINESS SERVICE PROVIDER #4

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #5

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #6

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider
BUSINESS INFORMATION
BUSINESS SERVICE PROVIDERS

BUSINESS SERVICE PROVIDER #7

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #8

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #9

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider
BUSINESS INFORMATION
BUSINESS SERVICE PROVIDERS

BUSINESS SERVICE PROVIDER #10

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #11

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #12

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider
BUSINESS INFORMATION
BUSINESS SERVICE PROVIDERS

BUSINESS SERVICE PROVIDER #13

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #14

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider

BUSINESS SERVICE PROVIDER #15

Service Provider Name
Address Breed
Phone/Email
Describe How this Provider
Helps your Business
Cost
Service Provider Schedule

Any Special Instructions

for Service Provider
BUSINESS INFORMATION
BUSINESS ELECTRONICS PASSWORDS
Below, write the passwords for all your BUSINESS electronic devices. Make sure to fill in both the
electronic item and the password. Some examples include:
• Cell Phones • Computers
• Voicemail Passwords • Tablets

ELECTRONICS PASSWORDS
Device Name/Description Password
Account Number

Location of Checkbook

BUSINESS SOCIAL MEDIA ACCOUNTS

Below, write the login information for all your BUSINESS social media accounts.
Examples include Facebook, Instagram, YouTube, Twitter, LinkedIn, etc.

BUSINESS SOCIAL MEDIA ACCOUNT LOGIN INFORMATION

Social Media Site Login Email or ID Password
Account Number

Location of Checkbook
 BUSINESS INFORMATION
BUSINESS EMAIL ACCOUNTS
Below, write the login information for all your BUSINESS email accounts.

EMAIL ADDRESS #1
Email Address
Email Belongs To Account Number
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #2
Email Address
Email Belongs To Account Number
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #3
Email Address
Email Belongs To Account Number
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #4
Email Address
Email Belongs To Account Number
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #5
Email Address
Email Belongs To Account Number
Email Login
Email Password Location of Checkbook
 BUSINESS INFORMATION
ONLINE BUSINESS ACCOUNT LOGINS & PASSWORDS
Below, write the login information for all your BUSINESS online accounts. Examples include:
• Financial Accounts (Bank Accounts, Investment Accounts, etc)
• Liability Accounts (Credit Card Accounts, Business Loans, etc)
• Online Accounts with your Business Service Providers
• Online Business Software

ONLINE ACCOUNT #1
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #2
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #3
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #4
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #5
Account Name/Service
Login URL Account Number
Username Password
What is this account for?
 BUSINESS INFORMATION
ONLINE BUSINESS ACCOUNT LOGINS & PASSWORDS
ONLINE ACCOUNT #6
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #7
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #8
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #9
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #10

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #11

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
 BUSINESS INFORMATION
ONLINE BUSINESS ACCOUNT LOGINS & PASSWORDS
ONLINE ACCOUNT #12
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #13

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #14

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #15

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #16

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #17

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
 BUSINESS INFORMATION
BUSINESS PHYSICAL STORAGE
This section outlines instructions on how to access physical storage you for your BUSINESS
such as:
• Safes • PO Boxes
• Safety Deposit Boxes • Storage Units

SAFE #1
Location of Safe
Combination to Safe Account Number
Location of Key Password
Contents of Safe

SAFE #2
Location of Safe
Combination to Safe Account Number
Location of Key Password
Contents of Safe

SAFETY DEPOSIT BOX #1

Location of Safety Deposit Box
Box Number Account Number
Location of Key to Open Password
Contents of Box

SAFETY DEPOSIT BOX #2

Location of Safety Deposit Box
Box Number Account Number
Location of Key to Open Password
Contents of Box
 BUSINESS INFORMATION
BUSINESS PHYSICAL STORAGE
PO BOX #1
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

PO BOX #2
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

STORAGE UNIT #1
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

STORAGE UNIT #2
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

 BUSINESS INFORMATION
BUSINESS PHYSICAL STORAGE
PO BOX #1
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

PO BOX #2
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

STORAGE UNIT #1
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

STORAGE UNIT #2
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

 BUSINESS INFORMATION
BUSINESS FINAL WISHES
Below, outline instructions for what you want to happen to your business in the event of your
death or you and your spouse’s death.

DISCLAIMER: This is simply a summary of your wishes and in no way is the information in this section
legally binding. You are advised to have the details below stated in your will & estate plan documents.
 logins &
passowrds
LOGINS & PASSWORDS
This section outlines all your LOGIN & PASSWORD
information for your:
• Electronics • Email Accounts
• Social Media Accounts • All Online Accounts
• Physical Storage

ELECTRONICS PASSWORDS
Below, write the passwords for all your electronic devices. Make sure to fill in both the electronic
item and the password. Some examples include:
• Cell Phones • Computers
• Voicemail Passwords • Tablets

ELECTRONICS PASSWORDS
Device Name/Description Password
Account Number

Location of Checkbook
LOGINS & PASSWORDS
SOCIAL MEDIA ACCOUNTS
Below, write the login information for all your social media accounts for both yourself, your spouse, and
anyone else in your family. Examples include Facebook, Instagram, YouTube, Twitter, Snapchat, etc.

SOCIAL MEDIA ACCOUNT LOGIN INFORMATION

Social Media Site Login Email or ID Password
Account Number

Location of Checkbook
LOGINS & PASSWORDS
EMAIL ACCOUNTS
Below, write the login information for all your email accounts for both yourself,
your spouse, and anyone else in your family.

EMAIL ADDRESS #1
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #2
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #3
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #4
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook
LOGINS & PASSWORDS
EMAIL ACCOUNTS
Below, write the login information for all your email accounts for both yourself,
your spouse, and anyone else in your family.
EMAIL ADDRESS #5
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #6
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #7
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook

EMAIL ADDRESS #8
Email Address
Email Belongs To Account Number
Email Host (Gmail, Yahoo, etc.) Personal/Work?
Email Login
Email Password Location of Checkbook
LOGINS & PASSWORDS
ONLINE ACCOUNT LOGINS
Below, write the login information for all your online accounts. Examples include:
• Financial Accounts (Bank Accounts, Investment Accounts, Retirement Accounts, etc)
• Liability Accounts (Mortgage Account, Car Loans, Credit Card Accounts, Student Loans, etc)
• Online Bill Accounts (Cable, Phone, Utilities, Insurance Policies, etc.)
• Subscriptions (Netflix, Spotify, Amazon Prime, etc.)
• Other MISC Accounts (iCloud, iTunes, PayPal, Travel Rewards Accounts, etc)

TIP: Go through your last 3 months of expenses and record account login information for services and companies you have used recently. The
most important are accounts that are linked to your bank accounts and could potentially keep charging you if not closed out.

ONLINE ACCOUNT #1
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #2
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #3
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #4
Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #5
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #6
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #7
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #8
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #9
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #10

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #11
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #12

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #13

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #14

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #15

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #16

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #17
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #18

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #19

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #20

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #21

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #22

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #23
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #24

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #15

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #26

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #27

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #28

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #29
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #30

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #31

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #32

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #33

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #34

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
ONLINE ACCOUNT #35
Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #36

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #37

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #38

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #39

Account Name/Service
Login URL Account Number
Username Password
What is this account for?

ONLINE ACCOUNT #40

Account Name/Service
Login URL Account Number
Username Password
What is this account for?
LOGINS & PASSWORDS
PHYSICAL STORAGE
This section outlines instructions on how to access physical storage you have such as:
• Safes • PO Boxes
• Safety Deposit Boxes • Storage Units

SAFE #1
Location of Safe
Combination to Safe Account Number
Location of Key Password
Contents of Safe

SAFE #2
Location of Safe
Combination to Safe Account Number
Location of Key Password
Contents of Safe

SAFETY DEPOSIT BOX #1

Location of Safety Deposit Box
Box Number Account Number
Location of Key to Open Password
Contents of Box

SAFETY DEPOSIT BOX #2

Location of Safety Deposit Box
Box Number Account Number
Location of Key to Open Password
Contents of Box
LOGINS & PASSWORDS
PHYSICAL STORAGE
PO BOX #1
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

PO BOX #2
Location of PO Box
PO Box Number & Address Account Number
Location of Key to Open Password
Other Information of Box

STORAGE UNIT #1
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

STORAGE UNIT #2
Location of Storage Unit
Storage Unit # Account Number
Code to Enter Facility Password
Code or Key Location to Open Unit

Contents of Unit

What to do with Contents

important
documents
 IMPORTANT DOCUMENTS
Below, outline details surrounding where you have your important documents stored.
In addition, make copies of any of the below documents and store them in this binder.
You can also upload digital copies of your documents and place them on a USB drive
stored in a secure location.
LOCATION OF IMPORTANT DOCUMENTS
DOCUMENT NAME DOCUMENT LOCATION
IDENTIFICATION & RELATIONSHIP DOCUMENTS
BIRTH CERTICIATES
SOCIAL SECURITY CARDS
PASSPORTS
DRIVER’S LICENSE
CITIZENSHIP PAPERS
MILITARY DOCUMENTS
MARRIAGE CERTIFICATE
PRENUPTUAL AGREEMENT
DIVORCE PAPERS
ADOPTION PAPERS
GUARDIANSHIP PAPERS
ESTATE PLANNING DOCUMENTS
LIVING WILL/WILL PAPERS
POWER OF ATTORNEY (POA) PAPERS
HEALTHCARE POA PAPERS
BENEFICIARY DESIGNATION PAPERS
LETTER OF LAST INSTRUCTION
CEMETERY DEED
DEATH CERTIFICATES
HOUSEHOLD DOCUMENTS
MORTGAGE STATMENTS
MORTGAGE CLOSING DOCUMENTS
PROPERTY DEEDS
HOME INSPECTION REPORT
HOME APPRAISAL PAPERS
PROPERTY TAX ASSESSMENT
HOUSEHOLD INVENTORY & PHOTOS
RECEIPTS FOR WARRANTIED ITEMS
 IMPORTANT DOCUMENTS
LOCATION OF IMPORTANT DOCUMENTS
DOCUMENT NAME DOCUMENT LOCATION
FINANCIAL DOCUMENTS
BANK STATEMENTS
STOCKS/BONDS CERTIFICATES
TRUST PAPERS
PREVIOUS PAY STUBS
W2s
FORMER TAX RETURNS
RETIREMENT & INVESTMENT PAPERS
INHERITENCE RECORDS
CREDIT REPORTS
VEHICLE DOCUMENTS
VEHICLE TITLES
VEHICLE REGISTRATIONS
VEHICLE INSURANCE CARDS
VEHICLE SERVICE RECORDS
VEHICLE BILL OF SALE
HEALTH DOCUMENTS
HEALTH RECORDS
IMMUNIZATION RECORDS
MEDICAL DIRECTIVE
DO NOT RECESITATE (DNR)
EDUCATIONAL DOCUMENTS
DIPLOMAS
TRANSCRIPTS
PET DOCUMENTS
PROOF OF OWNERSHIP RECORDS
IMMUNIZATION RECORDS
OTHER DOCUMENTS
 copies of
important
documents
important
contacts
 IMPORTANT CONTACTS
In this section, document information for IMPORTANT CONTACTS in your life
that might not be documented in this binder up to this point such as:
• Extended Family Members • Lawyers
• Close Co-Workers • Financial Advisors
• Close Friends • Hairstylist
• Children Godparents • Other Personal Care
• CPAs Service Providers

IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
 IMPORTANT CONTACTS
IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
 IMPORTANT CONTACTS
IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
 IMPORTANT CONTACTS
IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
 IMPORTANT CONTACTS
IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
 IMPORTANT CONTACTS
IMPORTANT CONTACTS
Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes

Name
Relationship
Address
Phone
Email Address
Notes
letters to
loved ones
LETTERS TO LOVED ONES

In this section of your binder, feel free to

leave letters to your loved ones that can be
received after your passing.

People come and go. Everyone that’s been in your life

has been there for a reason, to teach you, to love you,
or to experience life with you.
- Anonymous
" IF YOU'RE GOING
TO LIVE, LEAVE A

legacy.
LEAVE A MARK ON
THE WORLD THAT
CAN'T BE ERASED."
MAYA ANGELOU