Personal and Financial Affairs Checklist for

End-of-Life Planning

Prepared by the New York State Funeral Directors Association, Inc.

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About us . . .

The Tribute Foundation was established to advance awareness related to death, dying and bereavement by fostering a better understanding of end-of-life issues for all New Yorkers. Its philanthropic vision is guided by its investments in consumer education and outreach, industry research, education for lifelong learning, and partnerships and collaborations.

The New York State Funeral Directors Association (NYSFDA) is the oldest association of funeral directors in the United States. Comprised of over 900 funeral firms employing more than 3300 licensed funeral directors, NYSFDA is the largest organization representing the interests of large and small funeral firms in New York State. Please visit our website: www.nysfda.org for a listing of funeral homes by county, that participate in PrePlan, NYSFDA’s prepaid funeral trust program. NYSFDA also has additional consumer resources on a variety of topics available online.

PrePlan is a funeral trust pre-funding program, backed by the New York State Funeral Directors Association, Inc. It currently administers over 75,000 consumer trust accounts for the more than 600 funeral homes in New York State. The funds entrusted with PrePlan are placed in FDIC-insured certificates of deposit (CDs) which provide you, as a consumer, with the combined financial benefit of safe, no risk investments that give you a maximum rate of interest. In addition, each account is fully insured up to $250,000. Our investments are diversified, and we will only do business with the highest-rated banking institutions.

About us . . .

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Personal & Financial Affairs Checklist

This checklist has been designed to assist you in organizing important information that will be readily accessible to your

survivors after your death. It will also help you preplan your funeral and leave a permanent record of these plans so that your family and/ or executor will be able to fulfill your wishes. Knowing what you wanted will relieve your loved ones of making decisions at a stressful time.

As part of your planning, you may choose to visit your funeral director and prearrange your funeral needs. This act will have some significant benefits for you and your family. First and foremost, it will relieve your family members of the many decisions that must be made at the time, of your death. They won’t have to try and guess what you would have wanted, they will know. In addition, if the funeral is prefunded, the family will not have to deal with any monetary considerations. Another benefit is that SSI/Medicaid recipients are allowed to set aside money to fully fund the funeral service of their choice prior to their own funds becoming exhausted. Finally, prearranging will give you the peace of mind knowing that you will have a funeral and burial which will fulfill your personal beliefs.

It is so very important to not be afraid of talking about death with your family members . . . death is an inevitable part of the life cycle and all living things will experience it. Discuss this booklet and checklist with them; involve them in the planning process. Discussing your beliefs and desires openly will assist in assuring that when death occurs, your final wishes are carried out and your survivors have the information necessary to make their grief easier to bear.

Personal & Financial Affairs Checklist

PERSONAL AFFAIRS CHECKLIST m Discuss Funeral Arrangementsm File Current/Updated Willm Cemetery Arrangementsm Monument Dealer m Funeral Home Details m Copies of Prearrangement Contracts m Biographical Informationm Estate Executor m Motor Vehicle Department m Firearms m Plans for Pets

FINANCIAL AFFAIRS CHECKLIST m Accountant m Bank Accountsm Credit Union Accountsm Safe Deposit Box(es)m Pensionsm Life Insurance m Stock Brokerm Real Estatem Social Security Administrationm Union Benefitsm Fraternal Benefitsm Veterans’ Benefits

Date Completed: ___________________

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Personal Affairs . . .

• DISCUSS FUNERAL ARRANGEMENTS

Everyone, at one time or another, has thought about what type of funeral they would like for themselves. Whether you choose to formally make prearrangements or not, it is very important to let family and/ or friends know what it is you desire for your funeral. Chances are a lot greater that your wishes will be carried out if people know what those wishes are.

• LAST WILL AND TESTAMENT

Contact an attorney to have a will written or make updates to an older one. Be sure family and friends know your attorney’s name and where the will is filed.

CEMETERY/CREMATION INFORMATION

MONUMENT INFORMATION

FUNERAL HOME DETAILS

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The Details . . .

______________________________________________ (Prearrangement Contract Number)

______________________________________________ (Location of Copies of Contract)

______________________________________________(Where Funeral Service to be held-in Church, Funeral Home or Other)

______________________________________________ (Visitation/Calling Hours)

______________________________________________ (Clergy Chosen)

______________________________________________ (Clergy Chosen)

______________________________________________ (Pallbearers)

______________________________________________ (Pallbearers)

______________________________________________ (Pallbearers)

A Military Service ___ Yes ___ No

Music (List Selections)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Clothing (List Selections)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Flowers (List Favorites)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Memorials / Contributions (List Choices)

______________________________________________

______________________________________________

______________________________________________

Other Special Requests (List)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

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Biographical Information

VITAL STATISTICS

______________________________________________ (Full Name)

______________________________________________ (Address)

______________________________________________ (City)

______________________________________________ (State) (Zip)

______________________________________________ (Phone Number)

______________________________________________ (Resident Since)

______________________________________________ (Place of Birth-city, county, state/province)

______________________________________________ (Date of Birth)

______________________________________________ (Social Security Number)

______________________________________________ (Name of Father)

______________________________________________ (Full Maiden Name of Mother)

______________________________________________ (Marital Status)

______________________________________________ (Spouse Name)

______________________________________________ (Church Affiliation)

EDUCATION

______________________________________________ (High School Attended)

Graduation Date ________________________

______________________________________________ (College Attended)

Graduation Date ________________________

Degree ________________________________

______________________________________________ (College Attended)

Graduation Date ________________________

Degree ________________________________

EMPLOYMENT HISTORY

______________________________________________ (Place of Employment)

______________________________________________ (Position)

______________________________________________ (Dates)

______________________________________________ (Place of Employment)

______________________________________________ (Position)

______________________________________________ (Dates)

______________________________________________ (Retirement Date)

Education / Employment History

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Family Information

LIST CHILDREN AND THEIR RESIDENCE (City, State)(If deceased, please indicate)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

IMPORTANT DOCUMENTSWhere are birth certificates/adoption papers/marriage certificates filed?

______________________________________________

______________________________________________

OTHER LIVING RELATIVES AND RESIDENCES (City, State)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

FRATERNAL AFFILIATIONS (List)

______________________________________________

______________________________________________

MILITARY SERVICE

______________________________________________(Branch of Service)

______________________________________________(Service Serial Number)

______________________________________________ (Date Entered) (Grade or Rank)

______________________________________________ (Place of Entry)

______________________________________________ (Name of War or Conflict)

______________________________________________(Date of Discharge)

______________________________________________ (Where Discharge Papers are Filed)

______________________________________________(Decorations)

______________________________________________ (Pension or V.A. Claim Number)

______________________________________________ (V.A. Disability?)

______________________________________________ (Flag Requested?)

______________________________________________(Veteran’s Cemetery Marker?)

Fraternal / Military Information

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ESTATE EXECUTOR

______________________________________________(Name)

______________________________________________(Address)

______________________________________________(City)

______________________________________________(State) (Zip)

______________________________________________(Phone Number)

Has this individual been informed of this role?

___ Yes ____ No

MOTOR VEHICLE DEPARTMENT

______________________________________________ (Location)

______________________________________________ (Phone Number)

List Vehicle(s) registered in your name and license plate number(s):

Vehicle _______________________________

Plate Number _________________________

Vehicle _______________________________

Plate Number _________________________

Executor / DMV Information

FIREARMS

List any and all firearms

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

PLANS FOR PETS

What arrangements should be made for your pets / animals?

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Other

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ACCOUNTANT

______________________________________________ (Name)

______________________________________________ (Address)

______________________________________________ (City)

______________________________________________ (State) (Zip)

______________________________________________ (Phone Number)

BANK / CREDIT UNION ACCOUNTS

______________________________________________ (List Financial Institution and Account Number)

______________________________________________ (List Financial Institution and Account Number)

______________________________________________ (List Financial Institution and Account Number)

______________________________________________ (List Financial Institution and Account Number)

Safe Deposit Box(es)

______________________________________________ (Located at) (Box #)

PENSION PLAN(S)

______________________________________________

______________________________________________

Financial Affairs

STOCKBROKER

______________________________________________ (Name)

______________________________________________ (Address)

______________________________________________ (City)

______________________________________________ (State) (Zip)

______________________________________________ (Phone Number)

REAL ESTATE

______________________________________________

______________________________________________

______________________________________________

______________________________________________

SOCIAL SECURITY ADMINISTRATION

______________________________________________(Phone Number)

LIFE INSURANCE (List Policy # and Company Name)

______________________________________________

______________________________________________

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UNION BENEFITS (List)

______________________________________________

______________________________________________

FRATERNAL BENEFITS (List)

______________________________________________

______________________________________________

VETERAN’S BENEFITS (List)

______________________________________________

______________________________________________

NOTES

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Benefits

Consider the concept of a digital will, a legally binding statement declaring who should have access to your information after you die. Think about how many passwords and online accounts you have.

MY E-MAIL ADDRESSES (List)

______________________________________________

______________________________________________

______________________________________________

FACEBOOK Yes m No m

Profile Name: __________________________________

OTHER SOCIAL MEDIA ACCOUNTS (List)

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

Passwords

Preplanning:

A Precious Gift to

Those You Love

Albany, NY 12205518-452-8230

Web: www.nysfda.org Email: info@nysfda.org

© Copyright NYSFDA, 2000, 2004, 2012

Have more questions? Please do not hesitate to ask your funeral director.

For a listing of funeral directors in your area, contact: