Final Affairs Guide. Address: City: State: Zip: Table of Contents

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1 Final Affairs Guide The purpose of this workbook is to help you organize your personal and legal information. After completion, please keep it in a safe place where it will be easily accessible to you (not a safety deposit box.) This guide is for City: State: Zip: Copies have been given to: Date completed: Revised on: Revised on: Revised on: Table of Contents Legal Matters Will Durable Power of Attorney for Finances Power of Attorney for Health Care Living Will Do Not Resuscitate Final Details Remember When? Important Information Vital Statistics Death Certificate Information Funeral Planning Worksheet People to Notify of my Death Sample Obituary Form The Community Bioethics Committee of Price County, Wisconsin has granted permission to reproduce and distribute this Final Affairs Guide as a public service. Final Affairs Guide 1

2 Legal Matters Will A will specifies how certain assets are to be distributed after your death. In the will you designate a personal representative (executor) who is responsible for carrying out the instructions in your will. A will does not affect some assets such as joint tenancies, retirement plans and life insurance policies where a beneficiary is designated. If you do not have a will, the Wisconsin Statutes designates how your assets are distributed at death. Will There are many reasons other than concern about taxes to prepare a will. For example, when there are minors who are going to be inheriting and there is no will with trust provisions, that child on turning 18, will receive the inheritance without any restrictions. It is a good idea to consult with an attorney to decide whether or not you need a will and to discuss what other estate planning you should do. People s circumstances in life do change, and it is a good idea to periodically review your circumstances and, if you have concerns, contact an attorney you trust. Durable Power of Attorney for Finances In a Durable Power of Attorney for Finances you can designate a first choice and additional choices of a person to handle financial decisions for you if you become incompetent or if you desire assistance. A Durable Power of Attorney for Finances is not just for older people. It is a good idea for everyone to consider. A Durable Power of Attorney for Finances can eliminate the need for a guardianship if a person does become incompetent for any reason and is designed to protect your interests by allowing you to make decisions in advance regarding your financial future. Durable Power of Attorney for Finances It is a good idea to discuss the need for and the form of a Durable Power of Attorney for Finances with legal counsel if you have questions or concerns. 2 Final Affairs Guide

3 Power of Attorney for Health Care The Power of Attorney for Health Care allows you to choose someone as your health care agent for the purpose of making health care decisions for you should you be unable to do so. The state of Wisconsin does not recognize any family member, including your spouse, as an automatic decision maker if you are not able to speak for yourself. Your health care agent (the person you choose to make health care decisions for you) should be someone who you feel confident will express your wishes regarding the health care you will receive should you become incapacitated. This document is a means of expressing your personal and religious values and philosophies regarding the medical treatment you wish to receive or limit. Further information regarding the Power of Attorney for Health Care is available through an attorney, a social worker or health care providers. Power of Attorney for Health Care Following are a few questions you may wish to think about before you complete a Power of Attorney for Health Care: 1. Who do you feel comfortable discussing your health care decisions with (other than your medical provider)? 2. Who do you feel would best represent your wishes should you be unable to make health care decisions for yourself? 3. What are your feelings and beliefs regarding artificial means of keeping people alive (example: tube feeding)? 4. Are there any exceptions to these thoughts or beliefs? 5. Have you discussed these thoughts with your physician? A Power of Attorney for Health Care goes into affect when two physicians or a physician and a psychologist agree in writing that you can no longer understand your treatment options or are no longer able to express your wishes in regards to treatment options to others. Living Will Living Will Living Will is another type of advance medical directive, but it is very limited in its usefulness. It does allow you to tell your physician your wishes regarding tube feeding and life-sustaining procedures, but is only applicable if you are in a terminal condition or a persistent vegetative state. It does not apply if a woman is pregnant, and does not allow you to designate someone to speak for you if you cannot make the medical decisions yourself. There are also many other treatment issues that it does not address. Final Affairs Guide 3

4 Do Not Resuscitate Bracelet Do Not Resuscitate is an order signed by both the physician and the patient for a bracelet (either plastic or through Medic Alert) which informs emergency medical personnel that, if you suffer a cardiac arrest, they are to provide comfort care only and not try to revive you by any means. This advance directive is helpful for those who are terminally ill or have medical conditions where cardiopulmonary resuscitation would be unsuccessful or the pain or harm caused by it would outweigh the benefits. This is the only advance directive that emergency medical personnel can legally follow regarding resuscitation. Contact your physician or health care provider for more information. Do Not Resuscitate Bracelet Final Details The death of a loved one is a very difficult time. Yet, during this time of grief, important financial arrangements need to be made. You should begin by collecting all necessary papers including: Copies of death certificate Copies of insurance certificates Social security numbers of the deceased, spouse and any dependent children Copies of certificate of discharge if deceased was a veteran Copies of marriage certificate Copies of birth certificates of dependent children Copy of the will Insurance policies Veteran s benefits Contact local VA representative for assistance and information on benefits. Social Security Contact your local social security office to determine survivor s benefits or for information on benefits. Employee benefits Contact for life insurance or final paycheck. Also contact past employers to determine if deceased was entitled to a pension plan. Finances Debts owed by the deceased will be the responsibility of the estate and should be forwarded to the personal representative or executor of the estate. Debts which are jointly owed should be paid by the survivor in order to keep a good credit rating. Professional Assistance You may benefit from the assistance of an attorney or financial planner. Grief support groups/education Contact your area hospice program, hospital or social service agency for information and referrals. Remember When? Looking Forward You may wish to attach information about special dates, photos, children, pets, videos, memories, stories to share, hiding places, family history or other items of special interest to you or your family. You can also include a list of important people/friends, letters to loved ones, regrets or lost opportunities and things you hope to see accomplished in the future. 4 Final Affairs Guide

5 Important Information BASIC FACTS Full name: Birthplace: Date of birth: Social Security #: Spouse/significant other: Employer or retired from: Birth certificate location: Marriage certificate location: Religious denomination: Church affiliation: Education: Medicare #: Medicaid #: Name of father: His birthplace: Name of mother: Her birthplace: Mother s maiden name: Political positions held: Special recognitions: DOCTOR Facility: Facility: DENTIST Facility: PHARMACY LAWYER Firm: OTHER (Podiatrist, Psychiatrist, Surgeon, Dermatologist, Oncologist, etc.) FINANCIAL ACCOUNTS STOCK BROKER Firm: FINANCIAL ADVISOR Firm: ACCOUNTANT EXECUTOR OF WILL Final Affairs Guide 5

6 BANK ACCOUNTS SAVINGS ACCOUNT SAVINGS ACCOUNT CHECKING ACCOUNT CHECKING ACCOUNT MONEY MARKET MONEY MARKET CERTIFICATE OF DEPOSIT CERTIFICATE OF DEPOSIT SAFE DEPOSIT BOX Financial institution: Location of key: INCOME TAX RECORDS Location of records: Tax preparer: CREDIT CARDS Company: Company: RETIREMENT INVESTMENTS IRA KEOGHS 401(K) ANNUITIES STOCK OPTIONS OTHER INVESTMENTS 6 Final Affairs Guide

7 SOCIAL SECURITY AND PENSIONS SOCIAL SECURITY Social Security Office: Disability benefits: Dependent benefits: Survivor benefits: PENSION Private employer: Civil Service: VETERANS ADMINISTRATION Contact & telephone: Veteran s full name: VA claim # : Service serial #: Date entered service: Place entered service: Branch of service: Rank or grade: Name of war/conflict: Date of discharge: Place of discharge: Decorations: Medal of Honor recipient: American flag request: Draped or not draped? Yes No Veteran s cemetery marker? Yes No INSURANCE POLICIES (Life, Health, Medical, Homeowners, Auto, Rental, Disability, Mortgage ) Life insurance company: Contact & telephone: Homeowners insurance: Contact & telephone: Automobile insurance: Contact & telephone: Description of vehicles: Description of vehicles: Location of titles: Health insurance: Contact & telephone: Other insurance: Contact & telephone: Other insurance: Contact & telephone: Final Affairs Guide 7

8 REAL ESTATE Primary residence: Address/P.O. Box: Location of deed: Bank or mortgage company: Appraisal of property: Rental property: Other information: OTHER REAL ESTATE (Time share, Vacation home, Co-op, Land, Condo ) Residence: Location of deed: Bank or mortgage company: Appraisal of property: Residence: Location of deed: Bank or mortgage company: Appraisal of property: Residence: Location of deed: Bank or mortgage company: Appraisal of property: OTHER BUSINESS CONTRACTS LOANS Address & telephone: Description: Address & telephone: Description: DEBTS Address & telephone: Description: Address & telephone: Description: OTHER CONTRACTS Address & telephone: Description: Address & telephone: Description: IMPORTANT NAMES AND NUMBERS Plumber: Electrician: Well/septic: Handyman: Gas/oil delivery: Garbage removal: Mechanic: Helpful hints: Fuses/circuit breakers: Where to turn off water: Furnace/hot water heater: Seasonal chores: Vehicle maintenance: Valuables/location: Valuables/location: Other: 8 Final Affairs Guide

9 Vital Statistics You will be asked by your funeral director for the following information to be included on the death certificate. Full legal name: Address/P.O. Box: Township: County: Sex: Male Female Race: Citizen of: Birthdate: Birthplace: Single Married Widowed Divorced Name of spouse: Maiden name (if wife): Date married: Place married: If spouse is deceased, date and place of death: Education (0-12 plus college): Social security #: Occupation : Employed by: Date of retirement: Mother s maiden name: Father s name: If a veteran name of war & dates of service: Death Certificate Information It is illegal to photocopy a certified copy of a death certificate. The fine can be up to $10,000. Use only certified copies of the death certificate for legal purposes. You may need a death certificate for the following: Automobile, ATV and boat titles Bank, savings & loan, credit card benefits and credit union accounts Contracts for deeds & cooperative stock Estate proceedings IRA accounts & life insurance bank, credit, life or accidental Lodge & fraternal benefits Medical insurance premium reimbursement Pension plans & railroad retirement Property titles Securities and stocks & bonds Social Security & veterans benefits Final Affairs Guide 9

10 Funeral Planning Worksheet For: Date: Special instructions/requests: Funeral Home: Funeral home name: Fax: Pre-arranged funeral made: Yes No Pre-arrangement contract: Yes No Where located: Person responsible for my arrangements: People to notify immediately after my death (see page 12 ) FINAL PLANS Traditional earth burial (non-cremation) Cremation: Direct cremation cremation of the deceased without a viewing or other ceremony at which the body is present Cremation after a ceremony Organ donation: Organ donor Driver s License Sticker Instructions on my Power of Attorney for Health Care Donation of body: To a medical or educational institution (name: ) Directly After a ceremony Immediate burial-no public visitation Memorial service to be held at Funeral with visitation Visitation held at: Funeral home Church Other ( ) Public Private (e.g. family only) Open casket viewing Closed casket Personal Items Clothing: Jewelry: Glasses: Yes No Other: 10 Final Affairs Guide

11 Flowers: Yes No (If yes, description) Plot: Section: Block: Location of deed: Memorials directed to: Clergy of choice: Cremation: Disposition of ashes: Urn Container Special wishes: Music: Special readings, poems, etc.: Scripture, holy readings: Military/lodge/other service: Contact person/phone: Casket bearers: Honorary bearers: Earth Burial (for body or ashes): Name of cemetery desired: Cemetery contact: Plot in whose name: Grave Marker: Flat Upright (check cemetery regulations) Purchased: Yes No Where? Epitaph: Military marker: If you are a military veteran, you are entitled to a grave marker. You will need to have a copy of your military discharge papers. Arrangements made: Yes No Not interested VA Service Officer: Note: Military marker is available for non-military spouses; contact your VA service officer or funeral director for instructions on obtaining one. Other: Final Affairs Guide 11

12 People to Notify of My Death It is helpful to leave a list of individuals that your survivors should contact after your death; this can be written or created as an list for the computer literate. Please notify the following immediately after my death: 12 Final Affairs Guide

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15 Sample Obituary Form Most newspapers charge for the publication of an obituary. Some newspapers publish free Death Notices. Prior to submitting an obituary for publication, you should inquire about publication charges., of (Name of deceased) (age) (Complete address) (City, State), died at (Place of death, e.g. home, nursing home, hospital) on under the care of. (Date of death) (home health or hospice if applicable) Services will be held at,, at (Time) (Day) (Date). Friends may call from to (Location of services) (Starts at) (ends at) at. (Location of visitation) (The following is optional) The family request that, in lieu of flowers, memorials be sent to (Name of person or organization) at. (Address, City, State, Zip) The family would like to acknowledge. (Name of deceased) was born (Date of birth) in (City and State). He/She was the son/daughter of. (Name of mother and father) He/She was married on (Date) to (Husband s full name/wife s maiden name) who survives or died on (Date). Survivors besides (his/her) (wife/husband) include: List full names of survivors (children, siblings, parents) and city/state of residence and number of grandchildren and greatgrandchildren. Special friends may also be named. In addition, you may wish to include the following: Continued on next page Final Affairs Guide 15

16 (Sample Obituary Form Continued) Predeceased by: (Name and date of death) Deceased s educational background Employment background Military service (Company, location, length of employment) (Branch and dates of service) (Awards/decorations) Membership in clubs, fraternal organizations: Hobbies/interests: List of survivors: include 1st name of child (child s spouse) last name, city & state of residence Children: Siblings: Parents: Number of grandchildren: Number of great-grandchildren: Special friends: 16 Final Affairs Guide