Lasting Legacy - AARP

1 Contains Confidential and Personal Information Keep in Secure LocationMy Name _____ Address _____ City _____ State _____ ZIP _____Telephone Number _____Personal AdvisorsList the names of personal advisors with whom you have a current working relationship. (If you re not currently working with anyone, please indicate this.)PositionFirmNameComplete AddressTelephone NumberAttorneyAccountantBank or Trust OfficerInvestment BrokerLife Insurance AgentOtherOtherLastingLegacyAARP Foundation | 601 E Street, NW | Washington, DC 20049 | 1-800-775-6776 | Estate Planning Educational Series of the AARP Foundation | Part 4 Personal InformationI was born in _____on _____Location of birth certificate _____ Location of copy_____Social Security number _____Location of Social Security card _____Marital status.

2 C Single c Married c Widowed c Divorced c Legally SeparatedSpouse s name _____Date of birth _____ Social Security number _____Place/date of marriage _____Location of certificate _____There (circle one) is is not a prenuptial agreement. A copy of this prenuptial agreement islocated at _____Previous marriage(s): Name _____ Date(s) of marriage _____This marriage was terminated by: (circle one) Death Divorce Legal SeparationLocation of papers Citizen?

3 (circle one) Yes NoIf not citizen by birth, list date/place of naturalization _____Location of papers _____Other citizenship government publication #121Z. Where to Write for Vital Records, provides information on obtaining certified copies of birth, death, marriage and divorce records. Send a check or money order (payable to Superintendent of Documents) for $ to R. Woods, Consumer Information Center, 3C, PO Box 100, Pueblo, CO 81002 or go to Security RecordsMy last Social Security earnings report is located at _____My Social Security checks are are not directly deposited to my account number _____ at _____ Address _____My federal, state (city) income tax returns for the years _____are located at _____The person who prepared these returns is _____Address _____(City/State)(Date)(City/State)(Fina ncial Institution)

4 (Name, Complete Address, Telephone Number)(Complete Address)(Complete Address)(Account Number)(circle one)Military ServiceI served in the _____from _____ to _____. My serial number was _____Medical RecordsPositionNameComplete AddressTelephone NumberPhysicianDentistOtherOtherOtherOth erLiving Will: I have a Living Will stating my wishes for medical care and treatment if I am seriously document is dated _____and is located at _____The name and addresses of individuals who have copies are:Name _____Address _____Telephone Number _____Name _____Address _____Telephone Number _____Power of Attorney for Health Care.

5 I have given a Power of Attorney for health care decisions to: Name _____Address _____Telephone Number _____The power of attorney is dated _____ A copy is located at _____3 The Estate Planning Educational Series of the AARP Foundation | Part 4 (Mo/Yr)(Mo/Yr)(Complete Address)(Complete Address)(Complete Address)Pension InformationI am a participant in the following pension, retirement or death benefit plans:Type of PlanCompany Name/Complete AddressValueBeneficiaryEmployee Benefits Officer _____ Company _____ Phone _____Employee Benefits Officer _____ Company _____ Phone _____Employee Benefits Officer _____ Company _____ Phone _____Papers relating to my current business connections and agreements ( , buy-sell agreements, stock purchase plans, stock options) are located at _____AssetsBank Acct.

6 NameAccount NumberComplete AddressJoint Owner (see Note A next page)The following records are also on my home computer, filed under: _____4 The Estate Planning Educational Series of the AARP Foundation | Part 4 (Complete Address) Individual who has power to sign checks for me: Name _____Complete Address _____Certificates of DepositBankComplete AddressAmountMaturity DateCertificate NumberMy bank records are located at _____Safety Deposit BoxesBox LocationComplete AddressBox NumberKey LocationOther People with AccessNote A:1.

7 If the joint owner is not your spouse, keep accurate records showing how the assets were acquired and with whose funds. Estate and gift tax consequences will often depend on how the property was acquired. Good record keeping can often reduce You should also note if any jointly owned assets are community Estate Planning Educational Series of the AARP Foundation | Part 4 Securities (Attach list if needed)Company/FundComplete AddressJointly Held with (see Note A above)Number of SharesDate of PurchaseMy securities are located at _____My brokerage/mutual fund statements are located at _____My stockbroker is _____ Firm _____Address _____ _____Telephone Number _____The securities on previous page are pledged against loans _____They are held by _____ Firm _____Address _____ _____Telephone Number _____Closely Held Stock And/Or Limited Partnerships (Other Interests)InvestmentJointly Held with (see Note A )

8 AmountDate of InvestmentPercent of Ownership6 The Estate Planning Educational Series of the AARP Foundation | Part 4 (Complete Address)(Complete Address)(Complete Address)(Complete Address)Government Securities (If not with a broker)Type of SecurityJointly Held with (see Note A )Serial NumberDate of PurchaseRecords are located: (Complete Address)Individual Retirement AccountsName of FundCompanyAccount NumberComplete AddressTelephone NumberInsurance Policies (Accident/Disability/Health Care)TypeCompanyPolicy NumberCoverageLocation of Records (Complete Address)7 The Estate Planning Educational Series of the AARP Foundation | Part 4 My accident/disability/health care insurance agents are.

9 _____Address _____ _____Telephone Number _____Life Insurance PoliciesCompanyPolicy NumberFace ValueBeneficiariesThese policies and any supporting papers are located at _____I have unpaid loans against these policies:Policy Number: _____ Amount of Loan _____ Amount Still Due _____Companies or organizations holding insurance policies on my life:Company_____ Amount of Coverage _____Beneficiary _____The following are policies on my life owned by others:Owner _____ Relationship _____Address _____ Person paying premium _____Insurance Company _____Policy Number _____ Face Value _____I own policies on the lives of.

10 Name of Insured _____ Insurance Company _____Policy Number _____ Face Value _____ Beneficiary _____8 The Estate Planning Educational Series of the AARP Foundation | Part 4 (Complete Address)(Complete Address)(Complete Address)Real Estate Owned (Attach list if needed)DescriptionLocation (Complete Address)Status Held (See Below- A-E)Jointly Held WithTitle is held in: A) my name onlyB) together with (fill in name) _____C) as tenants by the entirety D) as joint tenants (right of survivorship) E) as tenants in common/as community propertyThe remaining mortgage on the property is $ _____ held by _____All papers pertaining to real estate holdings are located at _____Other Income Producing Assets (Patents, Copyrights, etc.