| My
full name: |
___________________________ |
| Date: |
___________________________ |
| Social
Security Number: |
_____ - _____ - _____ |
| Type
of service I have chosen: |
___________________________ |
| Funeral
establishment selected: |
___________________________ |
| Location
of my FCAFL membership form: |
___________________________ |
| Location
of my obituary and instructions regarding my funeral and memorial
service: |
___________________________ |
|
___________________________ |
|
|
| Location
of instructions if I die while out of the area: |
___________________________ |
| Name/phone
number of minister, rabbi, or other person whom I chose to lead the
service: |
___________________________ |
|
___________________________ |
|
|
| Name/addresses/phone
numbers of family members/friends to be notified (or location of this
information) |
|
| ______________________________________________________ |
| ______________________________________________________ |
| ______________________________________________________ |
| ______________________________________________________ |
|
|
| Location
of my current will: |
___________________________ |
| Name/phone
number of my attorney: |
___________________________ |
| Location
of my birth certificate, marriage license, divorce decree: |
___________________________ |
| Location
of my insurance policies: |
___________________________ |
| Name/phone
number of my insurance advisor: |
___________________________ |
| Location
of titles to realty owned, records on improvements, etc.: |
___________________________ |
| Location
of bank accounts, passbooks or similar records: |
___________________________ |
| Location
of my securities, fund accounts, and related papers: |
___________________________ |
| Name/phone
number of my financial advisor: |
___________________________ |
|
___________________________ |
| Location
of my safe deposit box and location of key: |
___________________________ |
|
___________________________ |
|
|
| Location
of my tax returns for the past 6 years: |
___________________________ |
| Name/address/phone
of my executor: |
___________________________ |
|
___________________________ |
|
___________________________ |
|
|
| Name/address/phone
of my accountant or tax preparer: |
___________________________ |
|
___________________________ |
|
___________________________ |
|
|
|
|
| Name
of those with copies of this form: |
___________________________ |
| |
___________________________ |
| |
___________________________ |
| |
___________________________ |
