Personal History Action Checklists The checklists in Chapter 1 are set out in the following order: • Personal History • Awards • Biography • Contacts • Education • Employment • Memberships • Personal Medication Record • Pets • Religion, Politics, and Hobbies • Residences • Where to Find It • Personal History: Other
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Personal History Name:___________________________________________________________________ First Middle Last Name at birth:_____________________________________________________________ First Middle Last Place of birth:_____________________________________________________________ City State Country Date of birth:______________________________________________________________ Date of adoption:___________________________________________________________ Legal name change:________________________________________________________ First Middle Last Legal name change date:_____________________________________________________ Legal name change court:____________________________________________________
Court
City
State
******** Current address:_ __________________________________________________________ ________________________________________________________________________ How many years:__________________________________________________________ Phone:__________________________ Cell phone:_______________________________ Email:________________________________ Fax:_______________________________ ********
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Chapter 1: Personal History Action Checklists
Occupation or industry:______________________________________________________ How many years:__________________________________________________________ ******** Citizenship:_______________________________________________________________
□ By birth □ By naturalization
Naturalization date:_________________________________________________________ Naturalization place:________________________________________________________
City
State
Country
******** Military veteran:
□ Yes □ No
Branch of service: _________________________________________________________ Dates of service: ___________________________________________________________ Serial # (DD214): _________________________Rank:____________________________ Type of discharge: _________________________________________________________ ******** Social Security #:__________________________________________________________ Passport #: ______________________________________ Expiration:_______________ Country of issue: __________________________________________________________ Drivers license #: _________________________________ Expiration:_______________ State of issue:_____________________________________________________________ ******** I am registered to vote at Precinct:__________ County: ________________ State: _______
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Faith/Denomination: _______________________________________________________ Place of worship: __________________________________________________________ Address: _________________________________________________________________ Pastor/Priest/Rabbi/Spiritual leader: ___________________________________________ Phone:__________________________ Email:___________________________________ ******** My blood type: ____________________________________________________________ ******** Marital Status:
□□ Divorced □□ Married □□ Never married □□ Widowed
First Spouse Name of spouse at birth:_____________________________________________________ Date of birth:______________________________________________________________ Place of birth:_____________________________________________________________ Date of marriage:__________________________________________________________ Date of divorce:____________________________________________________________ Date of death:_____________________________________________________________ Spouse is buried at:_________________________________________________________ Cause of death: ____________________________________________________________ Name at present: __________________________________________________________ Phone:__________________________ Email:___________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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Chapter 1: Personal History Action Checklists
Second Spouse Name of spouse at birth: ____________________________________________________ Date of birth:______________________________________________________________ Place of birth:_____________________________________________________________ Date of marriage:__________________________________________________________ Date of divorce:____________________________________________________________ Date of death:_____________________________________________________________ Spouse is buried at:_________________________________________________________ Cause of death:____________________________________________________________ Name at present:___________________________________________________________ Phone:__________________________ Email:___________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Third Spouse Name of spouse at birth:_____________________________________________________ Date of birth:______________________________________________________________ Place of birth:_____________________________________________________________ Date of marriage:__________________________________________________________ Date of divorce:____________________________________________________________ Date of death:_____________________________________________________________ Spouse is buried at:_________________________________________________________ Cause of death:____________________________________________________________ Name at present:___________________________________________________________ Phone:__________________________ Email:___________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Awards I received the following academic awards and scholarships: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I received the following athletic awards and scholarships: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I received the following work-related awards and commendations: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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© American Bar Association
Chapter 1: Personal History Action Checklists
Biography These are the highlights to include in my biography: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Contacts Advisers Accountant:_______________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Attorney:_________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Banker:__________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Executor:_________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Insurance agent:___________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ 14
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Chapter 1: Personal History Action Checklists
Investment adviser:_________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Tax adviser:_______________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Spiritual leader/Pastor/Priest:_________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Other: ___________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Medical Professionals Primary physician:_________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Specialty physician:________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Specialty physician:________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Dentist:__________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Other:___________________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Service Providers Children’s babysitter:_______________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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Chapter 1: Personal History Action Checklists
Children’s dentist:__________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Children’s physician:_______________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Children’s school/Daycare:___________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Housekeeper:______________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Lawn service/Gardener:_____________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Home health agency:________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Home maintenance:________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Pet’s veterinarian:__________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Property manager:__________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________ Security system:___________________________________________________________ Phone:__________________________ Email:___________________________________ Website:__________________________________________________________________ Address:_________________________________________________________________ ________________________________________________________________________
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© American Bar Association
Chapter 1: Personal History Action Checklists
Education I attended the following elementary or grade schools: Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________
I attended the following middle schools, junior high schools, or high schools: Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ I attended the following preparatory schools: Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ Name of school:___________________________________________________________ Location:_________________________________________________________________ Grades attended:_______________ Dates attended:_______________________________ © American Bar Association
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
I attended the following colleges or universities: Name of school:___________________________________________________________ Location:_________________________________________________________________ Degree/Certificate:_________________________________________________________ Dates attended/Graduated:___________________________________________________ Name of school:___________________________________________________________ Location:_________________________________________________________________ Degree/Certificate:_________________________________________________________ Dates attended/Graduated:___________________________________________________
I attended the following additional schools and training programs: Name of school:___________________________________________________________ Location:_________________________________________________________________ Degree/Certificate:_________________________________________________________ Dates attended/Graduated:___________________________________________________
I was involved in the following extracurricular activities (art, athletic, debate, drama, fraternity, music, school newspaper, sorority, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 20
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Chapter 1: Personal History Action Checklists
Employment I am presently employed at the following company and job:
______________________________________
Employer:
Address:________________________________________________________________ Contact:_________________________________________________________________ Type of work/Job title:_____________________________________________________ I worked at the following companies and jobs listed below:
______________________________________
Employer:
Address:________________________________________________________________ Contact:_________________________________________________________________ Type of work/Job title:_____________________________________________________ Dates: __________________________________________________________________
______________________________________
Employer:
Address:________________________________________________________________ Contact:_________________________________________________________________ Type of work/Job title:_____________________________________________________ Dates: __________________________________________________________________
______________________________________
Employer:
Address:________________________________________________________________ Contact:_________________________________________________________________ Type of work/Job title:_____________________________________________________ Dates: __________________________________________________________________
______________________________________
Employer:
Address:________________________________________________________________ Contact:_________________________________________________________________ Type of work/Job title:_____________________________________________________ Dates: __________________________________________________________________ © American Bar Association
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
_______________________________________
Employer:
Address:_________________________________________________________________ Contact:__________________________________________________________________ Type of work/Job title:______________________________________________________ Dates: ___________________________________________________________________
_______________________________________
Employer:
Address:_________________________________________________________________ Contact:__________________________________________________________________ Type of work/Job title:______________________________________________________ Dates: ___________________________________________________________________
_______________________________________
Employer:
Address:_________________________________________________________________ Contact:__________________________________________________________________ Type of work/Job title:______________________________________________________ Dates: ___________________________________________________________________ I retired on: ________________________________________________________ (Date) These accomplishments and interesting projects concerning my employment may be of interest: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 22
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Chapter 1: Personal History Action Checklists
Memberships I belong to the following organizations: Membership organization: ___________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Involvement: _____________________________________________________________ Interesting facts: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Membership organization: ___________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Involvement: _____________________________________________________________ Interesting facts: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Membership organization: ___________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Involvement: _____________________________________________________________ Interesting facts: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
© American Bar Association
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Membership organization: ___________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Involvement: _____________________________________________________________ Interesting facts: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Membership organization: ___________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Involvement: _____________________________________________________________ Interesting facts: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I have the following season tickets: Sports: __________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Seat numbers: _____________________________________________________________ Theater: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Seat numbers: _____________________________________________________________
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© American Bar Association
Chapter 1: Personal History Action Checklists
Personal Medication Record
My Medical Conditions: __________________________________
My Personal Information:
__________________________________
Name:_____________________________
__________________________________
Date of birth:________________________
__________________________________
Phone:_____________________________
__________________________________
Emergency Contact: Name:_____________________________ Relationship:________________________ Phone Number:______________________
__________________________________ __________________________________ __________________________________ __________________________________ __________________________________
Primary Care Physician:
__________________________________
Name:_____________________________
My Allergies:
Phone:_____________________________
__________________________________
Website:____________________________
__________________________________
Pharmacy/Drugstore:
__________________________________
Name:_____________________________ Pharmacist:_________________________ Phone:_____________________________ Website:____________________________
__________________________________ __________________________________ __________________________________ My Notes:
Other Physicians:
__________________________________
Name:_____________________________
__________________________________
Specialty:___________________________
__________________________________
Phone:_____________________________ Website:____________________________ Name:_____________________________ Specialty:___________________________ Phone:_____________________________ Website:____________________________
© American Bar Association
__________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________
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Reason
Form
Dosage
When
Be sure to include all prescription drugs, over-the-counter drugs, vitamins, and herbal or dietary supplements.
What
Medications Notes
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
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Chapter 1: Personal History Action Checklists
Pets I own the following pets: Pet name: ________________________________________________________________ Type/Species/Coloring: _____________________________________________________ Birth date: __________________ Ownership/Adoption date:_______________________ Instructions on food, water, care, exercise: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Veterinarian: ______________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Breeder: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Groomer: ________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Pet name: ________________________________________________________________ Type/Species/Coloring: _____________________________________________________ Birth date: __________________ Ownership/Adoption date:________________________ Instructions on food, water, care, exercise: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Veterinarian: ______________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Breeder: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Groomer: ________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________
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Chapter 1: Personal History Action Checklists
Pet name: ________________________________________________________________ Type/Species/Coloring: _____________________________________________________ Birth date: __________________ Ownership/Adoption date:________________________ Instructions on food, water, care, exercise: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Veterinarian: ______________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Breeder: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Groomer: ________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Pet name: ________________________________________________________________ Type/Species/Coloring: _____________________________________________________ Birth date: __________________ Ownership/Adoption date:________________________ Instructions on food, water, care, exercise: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Veterinarian: ______________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Breeder: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Groomer: ________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________
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Chapter 1: Personal History Action Checklists
Pet name: ________________________________________________________________ Type/Species/Coloring: _____________________________________________________ Birth date: __________________ Ownership/Adoption date:________________________ Instructions on food, water, care, exercise: ______________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Veterinarian: ______________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Breeder: _________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ Groomer: ________________________________________________________________ Phone: _____________________ Website:______________________________________ Address: _________________________________________________________________ ________________________________________________________________________ Email: ___________________________________________________________________ (See page 245 describing my wishes for the further care and placement of my pets.)
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Religion, Politics, and Hobbies My religious activities and beliefs are as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ My politics are as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ My hobbies are as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 32
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Chapter 1: Personal History Action Checklists
Residences I lived in the following cities and states at the addresses listed below: Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________
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Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ Address:_________________________________________________________________ City:________________________ State:________ Dates:__________________________ 34
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Chapter 1: Personal History Action Checklists
Where to Find It It’s important to let your family know where you have placed these items for safe keeping. If you are not sure where something is located, now might be a good time to locate it. If you don’t know where it is, your family may have an even harder time finding it. For each document or item, indicate where it is, such as in your safe deposit box, a fireproof box, a filing cabinet, or an electronic file, or with this book. Obviously, not everything needs to be, or even should be, stored in a safe deposit box; many items wouldn’t even fit. My safe deposit box is located at __________________________________ (bank name), ________________________ (address), __________________________ (box number).
Record Type
Safe Deposit Box
Other Location
Personal History Adoption papers Alimony settlement agreement Animal care information Annulment decrees or judgments Appointment book or calendar Athletic awards Award certificates Birth certificates Caregiving information: Children Caregiving information: Parents Change of name certificates Citizenship/naturalization
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____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Record Type
Safe Deposit Box
Other Location ____________________________
Divorce decrees or judgments
□ □ □ □
Durable power of attorney for finance
□
____________________________
Durable power of attorney for health care
□
____________________________
Dramatic awards
□ □ □ □ □ □ □ □ □ □ □ □ □ □ □
____________________________
Civic awards Cohabitation agreement Digital photos
Drivers license Educational awards Educational certificates Educational transcripts Employment awards Keys to post office box Keys to residence Keys to safe deposit box Keys to vehicles Keys to other real estate Lock combinations Membership awards Membership certificates Mental health power of attorney
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____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
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Chapter 1: Personal History Action Checklists
Record Type
Safe Deposit Box
Other Location ____________________________
Property settlement agreement
□ □ □ □ □ □ □ □ □ □ □ □
Qualified Domestic Relations Order (QDRO)
□
____________________________
Security system information
□ □ □ □ □ □ □ □
____________________________
Military awards Military separation papers Music/CDs catalog Other awards Passport Passwords Pet care Photo albums Postnuptial agreement Prenuptial agreement Property care information
Storage unit location Tax returns and records Timeshare records Videos/movies catalog Other Other Other
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____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Record Type
Safe Deposit Box
Other Location
Family History Adoption papers: Children Adoption papers: Pets Birth certificates Citizenship/naturalization papers Family tree Marriage certificates Newspaper articles Photo albums Portraits Other Other Other
□ □ □ □ □ □ □ □ □ □ □ □
____________________________
□ □ □ □ □ □ □ □
____________________________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Insurance Policies Annuities Automobile Boat Homeowner Life Long-term care Medical Medicare card
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____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
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Chapter 1: Personal History Action Checklists
Record Type Medicare Part D Medicare supplemental Pre-need funeral contract Renters Umbrella Other Other Other
Safe Deposit Box
Other Location
□ □ □ □ □ □ □ □
____________________________
□ □ □ □ □ □ □ □ □ □ □ □ □
____________________________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Benefits 401(k) agreements 403(b) agreements Disability agreements IRA agreements/statements Keogh plan agreements/statements Medicare summary notices Military separation papers Pension agreements SEP agreements/statements Social Security benefit statement Social Security card Workers’ compensation Other © American Bar Association
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____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Record Type Other Other
Safe Deposit Box
Other Location
□ □
____________________________
□ □ □ □ □ □
____________________________
□ □ □ □ □ □
____________________________
□ □ □ □
____________________________
____________________________
Banking and Savings Checking account statements Credit union account statements Savings account statements Other Other Other
____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Investments Brokerage account statements Certificates of deposit Savings bonds Other Other Other
____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Real Estate Cemetery deed Deeds Easements Home improvement records
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____________________________ ____________________________ ____________________________
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Chapter 1: Personal History Action Checklists
Record Type Land contracts Leases Mineral rights Mortgages Reverse mortgage Tax records Timeshare agreements Other Other Other
Safe Deposit Box
Other Location
□ □ □ □ □ □ □ □ □ □
____________________________
□ □ □ □ □ □ □ □ □ □
____________________________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Other Assets and Debts Business records Computers Copyrights Collectibles Credit card contracts Jewelry appraisals Jewelry inventory Patents and trademarks Rare books Vehicles
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____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Record Type
Safe Deposit Box
Other Location
□ □ □ □ □ □
____________________________
□ □ □ □ □ □ □
____________________________
____________________________
Cemetery deed
□ □ □
Cremation prearrangement agreement
□
____________________________
Ethical will/Legacy documents
□ □
____________________________
Vehicles’ certificates of title Warranties Websites Other Other Other
____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Estate Planning Durable power of attorney Letter of instruction Trust agreement Will and codicils Other Other Other
____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Final Wishes Body bequeathal papers Celebration of life prearrangements
Funeral prearrangement agreement
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____________________________ ____________________________
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Chapter 1: Personal History Action Checklists
Record Type Health care directives Legacy information Letters to be sent Living will Mausoleum deed Obituary Pet continuing care People to contact Uniform organ donor card Other Other Other
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Safe Deposit Box
□ □ □ □ □ □ □ □ □ □ □ □
43
Other Location ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
Checklist for My Family: A Guide to My History, Financial Plans, and Final Wishes
Personal History: Other The following miscellaneous information about me may be of interest: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 44
© American Bar Association
