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========================      PERSONAL INFORMATION DIRECTORY      ========================
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                   ===== VITAL STATISTICS AND HISTORICAL INFORMATION =====

Full Name:                                   Phone: 
Address:                                     City:                  State:       Zip: 
County: 
Birth date:            Birthplace: 
In city since:         In county since:           In state since: 
   []Single  []Married  []Widowed  []Divorced 
Social Security #:                   Union Local:              Local #: 
Employed By (or retired from):                               Job Title: 
Father's Name:                       Living: []Yes []No     Birthplace: 
Mother's Maiden Name:                Living: []Yes []No     Birthplace:
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                         ===== SPOUSE INFORMATION =====

Full Name:                         Living: []Yes []No              Date of Death: 
Social Security #:                 Birth date:         
Birthplace...                      City:                    State:           Zip: 
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                        ===== VETERANS INFORMATION =====

Branch of service:              Name of war:         Rank and rate at discharge: 
Service number:                 VA claim number: 
Place of enlistment:                         Place of discharge: 
Enlistment dates:           to  
Location of discharge papers:  in home:         other:
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                          ===== PEOPLE TO NOTIFY =====

In the event of an emergency, please notify the following people
to assist in any further arrangements. (relatives, friends,
neighbors, coworkers, supervisor)

Name:                              Relationship:            Phone:
   Address:                        City:                    State:           Zip:

Name:                              Relationship:            Phone:
   Address:                        City:                    State:           Zip:

Name:                              Relationship:            Phone:
   Address:                        City:                    State:           Zip:

Name:                              Relationship:            Phone:
   Address:                        City:                    State:           Zip:
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                ===== PERSON IN CHARGE OF FINAL ARRANGEMENTS =====

Name:                              Relationship:            Phone: 
   Address:                        City:                    State:           Zip:
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                       ===== LAST WILL AND TESTAMENT =====

I have prepared a will: []Yes   []No
I have prepared a Living Trust: []Yes   []No
I have prepared a living will: []Yes []No
Who has copies of any of the above documents?
   []my attorney    []my executor    []other:
Where are these documents located in my house:
My attorney is:                           Phone:
   Address:                        City:                    State:           Zip:

Executor/Executrix:                Relationship:            Phone: 
   Address:                        City:                    State:           Zip:
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                        =====INSURANCE INFORMATION =====

LIFE INSURANCE: 
   Company Name:                                 Policy #:                Phone:

ACCIDENT INSURANCE (if separate from Life Insurance):
   Company Name:                                 Policy #:                Phone:

HEALTH INSURANCE: 
   MAJOR MEDICAL: 
   Company Name:                                 Policy #:                Phone:
   
   LONG-TERM/NURSING-HOME CARE: 
   Company Name:                                 Policy #:                Phone:

HOME OWNER INSURANCE:
   Company Name:                                 Policy #:                Phone:

HOME PAYOFF INSURANCE (in event of death): 
   Company Name:                                 Policy #:                Phone: 

CAR INSURANCE: 
   Company Name:                                 Policy #:                Phone:

BUSINESS INSURANCE:
   Company Name:                                 Policy #:                Phone:
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             =====CHECKING, SAVINGS, & INVESTMENTS INFORMATION =====

Name of fiancial institution:                               Phone: 
   Address:                        City:                    State:           Zip:
   Checking account number(s): 
   Savings account number(s): 
   IRA account number(s):

Name of financial institution:                              Phone: 
   Address:                        City:                    State:           Zip:
   Checking account number(s): 
   Savings account number(s): 
   IRA account number(s):

Name of financial institution:                              Phone: 
   Address:                        City:                    State:           Zip:
   Checking account number(s): 
   Savings account number(s): 
   IRA account number(s):

Name of financial institution:                              Phone: 
   Address:                        City:                    State:           Zip:
   Checking account number(s): 
   Savings account number(s): 
   IRA account number(s): 
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                     ===== CREDIT CARD INFORMATION =====

Credit card name:                                Phone: 
   Address:                        City:                    State:           Zip:
   Account number:

Credit card name:                                Phone: 
   Address:                        City:                    State:           Zip:
   Account number:

Credit card name:                                Phone: 
   Address:                        City:                    State:           Zip:
   Account number:

Credit card name:                                Phone: 
   Address:                        City:                    State:           Zip:
   Account number: 
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                   ===== UTILITIES COMPANY INFORMATION =====

Phone company name:                              Phone: 
   Address:                        City:                    State:           Zip:
   Account number:

Gas company name:                                Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Electric company name:                           Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Water company name:                              Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Sewer company name:                              Phone:
   Address:                        City:                    State:           Zip:
   Account number:
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                   ===== SERVICE COMPANY INFORMATION =====

Garbage Disposal company:                        Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Internet Service company:                        Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Cable TV company name:                           Phone:
   Address:                        City:                    State:           Zip:
   Account number:

Newspaper delivery person:                       Phone:
   Address:                        City:                    State:           Zip:
   Account number:
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                      ===== HOME OWNER INFORMATION =====

Location of copy of deed, survey, & title insurance:

Mortgage company:                                Phone:
   Address:                        City:                    State:           Zip:
   Account number:
Who pays property tax? []You   []Mortgage company
Who pays sewer bill?:  []You   []Mortgage company
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                         ===== SAFE DEPOSIT BOX =====

Name of bank:                                    Phone: 
   Address:                        City:                    State:           Zip:
   Name of people who have keys:                 Phone:

Name of bank:                             Phone: 
   Address:                        City:                    State:           Zip:
   Name of people who have keys:                 Phone:
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                     =====FUNERAL SERVICE INSTRUCTIONS =====

Funeral Home:                                    Phone: 
   Address:                        City:                    State:           Zip:

Chapel:                                          Phone: 
   Address:                        City:                    State:           Zip:
Church Denomination:  

Minister:                                        Phone:  
   Address:                        City:                    State:           Zip:

Mass: []Yes []No
Place of Service: []Funeral Home  []In Church  []Graveside 
I Prefer: []Earth Burial  []Mausoleum  []Cremation 
My choice of cemetery is: 
   I Have Purchased Lots:[]Yes []No 
If interment is to be elsewhere: 
Ship To ________________________________ Funeral Home       Phone: 
   Address:                        City:                    State:           Zip:
Glasses:[]Yes []No    Rosary:[]Yes []No    Jewelry: []Yes []No    Clothing: []My Own []New 
Special Instructions: 
Counselor:

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Signature:                               Date:

Witness #1:                              Date:

Witness #2:                              Date: