Advisors: Some of the people you may need to contact are listed below: From:
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- Charles Copeland
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1 To my Family In an attempt to make things easier for you, I(We) have written this letter to provide you with information that will be necessary for you, when the time arises. From: My Social Security number is: My Driver s License number is: My Passport number is: The passport(s) can be found at: My important records can be found at: Advisors: Some of the people you may need to contact are listed below: Financial Planner: Attorney: Accountant: Mortgage Holder:
2 Insurance Agent: Other: Income: I work at: Company Contact Phone Number: I have the following benefits where I work or worked (briefly describe): Deferred Compensation: Stock Ownership: Stock Options: Cafeteria Plan: Other: I am the owner of the following business: Business Ownership Percentage: Other Owner(s): Contact Number: Contact Number: I have the following benefits through my business (briefly describe): Deferred Compensation: Buy/Sell Agreement: Stock Ownership: Stock Options: Cafeteria Plan: Other: I am retired, and have the following pension income: Company Contact Phone Number Monthly Income Survivor Benefit
3 Other Income: I receive monthly income from the following annuity: Company: Company: Policy Number: Policy Number: Monthly Income: Monthly Income: I am entitled to veterans benefits due to the following military service: Description of military service: Years of Service From: To: Contact the Veterans Administration at: Assets Here is a list of all my investment account. I have listed a contact person and telephone number for each item, as well as the location of any documents. Custodian: Account Number: Title of Account: Custodian Statements are located: Custodian: Account Number: Title of Account: Custodian Statements are located: Custodian: Account Number: Title of Account: Custodian Statements are located: Custodian: Account Number: Title of Account: Custodian Statements are located: Here is a list of other investments I own: Investment: Documents are located: Money is owed to us by: Amount: Investment: Documents are located: Amount:
4 Liabilities Here is a list of our liabilities, including a contact name and phone number of each, as well as the location of any related documents. Liability: Documents are located: Liability: Documents are located: Liability: Documents are located: Liability: Documents are located: Liability: Contact: Documents are located: Liability: Contact: Documents are located: I presently carry the following credit cards: Company: Card No.: Company: Card No.: Company: Card No.: Company: Card No.: Company: Card No.: Company: Card No.:
5 Insurance Coverage I have the following Life Insurance policies. Please check with each company and determine if: The policy allows for pre-payment of death benefits in the case of disability The policy allows you to stop making premium payments in the case of disability Type Owner Beneficiary Face Amount Company Phone Location of Policy I have the following other Insurance policies: Type of Insurance Company Policy No. Location of Policy Disability Long Term Care Health Insurance Umbrella Homeowners Auto _ Other Documents I have executed each of the following documents and you can find them where noted: Document Date Signed Location Will Medical Power of Attorney Medical Directive General Power of Attorney Living Trust Insurance Trust Charitable Trust Minor s Trust Pre-Nuptial Agreement Post-Nuptial Agreement Citizenship Papers Retirement Plan Beneficiary Designation I have appointed (in the above documents) the following persons to act on my behalf if I become disabled: Power of Attorney over my Assets: 1 st 2 nd Power of Attorney for Medical Decisions: 1 st 2 nd Guardian over my Property: 1 st 2 nd Guardian over my Person: 1 st 2 nd
6 It is my desire that the persons having the above powers of attorney act on my behalf rather than a guardian being appointed, unless my family believes guardianship is necessary. I have have not attached a list of the persons I want to receive my personal property when I die. My Medical Directive states that in the event of my incapacity, I do do not want to be kept at home as long as possible, taking into account the cost. I have do not have a divorce decree which may require that certain payments be made after I am disabled or after my death. This document is located: General Information My Safe Deposit Box can be found at: The combination is: The password to my computer is: My address is: Password is: My Facebook username/login is: Other passwords: I may receive an inheritance from: Upon my death, my heirs will will not receive a distribution or benefits from a trust. If yes, the trust instrument was created by: The trust can be found: I am currently the Trustee for a trust. If I am a Trustee, the trust document can be located at: I am a beneficiary of a trust. If I am a beneficiary, the trust document is located at: I am entitled to military and/or government benefits. The benefits are: I am entitled to other benefits. The benefits are: I am a member of the following religious group: I am a member of the following fraternal groups: I have provided the following for the education of my family:
7 In the Event of My Death Funeral Parlor: Prepaid Cemetery Plot: Cemetery: Plot/Drawer No.: Information can be found: I am an organ donor. My donor information is located: I have a deceased spouse, parent, child who is buried at and I wish do not wish to be buried next to such person. I do do not wish to be cremated. Crematory: Minister/rabbi to perform Service: Pallbearers: Special Request: Obituary Reading: Tombstone Engraving: Organs for Donation: In lieu of flowers, please ask for donations to: Other special requests: Family History I was born in on 19. My parents were and. My maternal grandparents were and. My paternal grandparents were and. My children are Born Born Born Born I have no children. I have detailed information on my family s history. It is located at:
8 Desires for My Family When I am gone, I hope my family will learn from my experiences: I believe that the most important things in life are: The most important thing I have done in my life is: It is my hope that my family will use its inheritance from me to accomplish the following goals in their lives: How I would like to be remembered: Information current as of, 20 Copies of this document are located at/with: Securities offered through LPL Financial, Member FINRA/SIPC This information is not intended to be a substitute for individualized legal advice and is for informational purposes only. Hesen and Haslam Retirement Income Specialists and LPL do not provide legal advice or services. Please consult your legal advisor regarding your specific situation.
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