Another Personal Record for Your use

I apologize for the poor quality of this document. However, it does contain a lot of useful information.

PERSONAL RECORDS FOR ________________________

Use this workbook to keep track of your personal records and information for your loved ones. Knowing this information will be helpful to your executor, agent and family if you die or become incapacitated. Keep these records in a safe place. Make sure an appropriate person knows where to look for them. Be sure to update these records from time to time.



1. Information Regarding These Records

This information was entered in this workbook on the _____ day of ________________, 20__, by_________________________________________________.


The original of these records is kept: (Give Location) ____________________________ _______________________________________________________________________.

(If applicable) A copy of these records is kept: (Give Location) ___________________ _______________________________________________________________________.



2. Personal Information

My legal residence is:




City State County

Date of Birth:
Month Day Year

Place of Birth:
City County State

Birth Records are located at:



If citizen of Date entered
Foreign country U.S.A.:

Citizenship Papers at:

I Currently Am Married to:
First Middle Maiden Name

Wedding: At
Mo. Day Year City County State

Birth Date of Spouse:
Month Day Year

Place of Birth:
City County State Country

My Children are: (List Name, Birthdate and Current Address)








If no children, list brothers and sisters.

Former Marriages (list all):

Former Spouse:
First Middle Maiden Name
If marriage ended in death:

Date
Month Day Year

Cause of Death:
Cause City Age

If marriage ended in divorce:

Date
Month Day Year

Place of Divorce:
City State

Records at:

Attorney:


Former Spouse:
First Middle Maiden Name
If marriage ended in death:

Date
Month Day Year

Cause of Death:
Cause City Age

If marriage ended in divorce:

Date
Month Day Year

Place of Divorce:
City State

Records at:

Attorney:
Former Spouse:
First Middle Maiden Name
If marriage ended in death:

Date
Month Day Year

Cause of Death:
Cause City Age

If marriage ended in divorce:

Date
Month Day Year

Place of Divorce:
City State

Records at:

Attorney:


Former Spouse:
First Middle Maiden Name
If marriage ended in death:

Date
Month Day Year

Cause of Death:
Cause City Age

If marriage ended in divorce:

Date
Month Day Year

Place of Divorce:
City State

Records at:

Attorney:


Parents:

Father:
Date Place

Born:

Died:

Buried at:

Mother:
(Maiden Name)

Date Place

Born:

Died:

Buried at:


Military Service:

No military service

Branch of
Service: Country

From: To:

Date of Type of
Discharge: Discharge:
Highest Grade
Or Rank Attained:

Employment:

My present employer is:
Name


Address Phone

Date Started: Supervisor:

Social Security No.:

Card located at:

In addition, I am eligible under the following pension, profit sharing and other benefit plans:

1.

2.

3.

4.

I am am not a member of a Labor Union.

Name of Local:


Address Phone

I am am not a member of a Credit Union.


Name Address

3. My Estate Planning Documents

My Will: I have no Will.

Original executed copy of my will is located at


It is dated ,

The original executed Codicil (revision), if any, is located at:


It is dated ,

Attorney who drew my will is:
Name Address Phone



Names of Executor(s) and Trustee(s):




Names of Guardians of my Children:




Witnesses to Will: (List Names and Addresses)




My Directive to Physicians and Family or Surrogates (“Living Will”):

I have a “Living Will” I have no “Living Will”

It is located at and is dated

My Medical Power of Attorney:

I have a Durable Power of Attorney for Property ____
I have no such power _____

It is located at and is dated


My Durable Power of Attorney for Property:

I have a Durable Power of Attorney for Property ____
I have no such power _____

It is located at and is dated

The attorney who drew this document is

My Declaration of Guardian:

I have a declaration of whom I want to be my guardian should the need later arise _____
I have no declaration of guardian _____

It is located at and is dated

My Trusts:

I have created (or am a beneficiary of) the following trusts:

Trust Name:
Date of Trust Instrument:
Original Trust Instrument is Located At:
Name and Address of Current Trustee:
Name and Address of Successor Trustee(s):


Trust Name:
Date of Trust Instrument:
Original Trust Instrument is Located At:
Name and Address of Current Trustee:
Name and Address of Successor Trustee(s):


Trust Name:
Date of Trust Instrument:
Original Trust Instrument is Located At:
Name and Address of Current Trustee:
Name and Address of Successor Trustee(s):

Other Estate Planning Documents: (Please describe and state location)





Insurance

Life Insurance:

I do do not have Life Insurance.

Complete itemized list can be found.





Policies are located at:



Policies Covering Others:

I own insurance policies on the lives of others. A list of companies and policy numbers is located at:



Name of persons insured:





I have have not made loans against some of the policies.

Source of Loan:


Address Phone

Pertinent papers are filed with the policies: (Check)
___ Endorsements ___ Dividend Payments
___ Premium Receipts ___ Assignments
___ Settlement Agreements


Annuities:

I do do not have annuities:

Detailed list is located at:




Location of annuity contracts:



My principal life insurance broker is:


Name


Address Phone


Medical and Long Term Care Insurance:

Accident, Hospitalization, Disability, Long term care and all other insurance (in addition to and exclusive of those covered by employer) not noted elsewhere.

Location of List:

Location of Policies:


Broker/agent Phone

Medicare:

I am am not registered for Medicare.

Enrollment at
Date City State

Medicare card located at:


5. My Assets and Liabilities

Safe Deposit Boxes:

I have have not a safe deposit box(es.)

Located at



Keys will be found at No.

No.

The following person has access: (Name and Address)

No.

No.




Accounts:

Checking
Accounts:
With Number


With Number

Savings
Accounts:
With Number


With Number

Other
Accounts:
With Number



With Number



With Number



With Number

Passbooks located at:



Accounts in joint names with myself and: (Name & Acct. No.)





Name of person who power to sign checks for me:


Address Phone

Real Estate:

I do do not own real estate. I am the sole owner.

It is located at:



Mortgage on my residence is held by:



The following documents are located at:
Check (X):

___ Deed ____ Mortgage Insurance Policy
____ Copy of Mortgage ____ Title Abstract
____ Improvement Loans ____ Closing Statement
____ Title Insurance ____ Leases
____ Tax Receipts ____ Maps & Surveys

Other Real Estate I own: _____ I am sole owner.









Documents pertaining thereto are located at:



Insurance Coverage is handled by:


Name of Broker Address Phone

Policies are located at:




I lease property to others: Yes No

Vacant Improved

To:
Name Address Phone

At
List Location

Leases can be found at:



U. S. Savings Bonds:

I do do not own U.S. Savings Bonds.

____ I am sole owner.

List of Bonds – Serial Numbers – Co-ownership – and who is a Beneficiary at my death can be found at:



Bonds are located at:



Securities (Stocks and Bonds):

I do do not own securities (Stocks & Bonds).

List of all securities and certificate numbers will be found at:



Certificates located at:



I do do not have a brokerage account.

Name of Broker or Firm:
Name

Address Phone


Records of Purchase and Sale are located at:




List Securities pledged for loans:

with
Lender Address

with
Lender Address

with
Lender Address



Personal Property:

I own the following personal property:

Auto: Yes No

1.
Make Year

2.
Make Year

Title(s) located at:




Household Furnishings: Yes No

Located at:

Record of Inventory located at:



Jewelry: Yes No Inventory List & Appraisals

at:

Boat: Yes No


Make Year


Motor Year

Located at:

Miscellaneous Personal Property – (not previously listed):







Pertinent insurance policies on personal property are located at:



Insurance Broker:
Name Phone

Proof of Ownership, Receipts, Bills of Sales, etc., are located at:



Miscellaneous Assets:

List here other assets you own that are not otherwise covered above.
















Credit Cards:

I possess the following credit cards:







Other Liabilities:

Mortgages, notes, and other debts not noted elsewhere.

Description:

Description:

Description:

Description:

Description:

Description:

Tax Records:

Copies of previous years tax returns filed are located at:



Party who prepared or assisted in tax returns:



Work sheets and evidence in support of returns are located at:



Current withholding tax forms and receipts received from my employer are located at:






6. Burial

(Please note: A special form is required to leave binding burial instructions. You can indicate your wishes here, but those indications are not binding on your family. Ask a lawyer at Barnes & Karisch, P. C. for more information.

I do do not own a cemetery lot.

Cemetery Lot:
Name of Cemetery Describe location

Deed located at:

There is is not provision for perpetual care.

I have given instructions regarding my funeral in:

Letter Other:

List membership in lodges or fraternal organizations providing cemetery benefits:







My preference for burial would be at:


Name of Cemetery City

Religious Affiliation:


List Church or Temple


Address


Pastor or Rabbi Phone






7. Persons Familiar With My Affairs

Please print name, address and phone number.

Attorney:



Accountant – Tax Counselors:



Banker:



Doctor:



Employer:



Funeral Director:



Insurance Agent:



Executor of Estate:



Fraternal or Professional Groups: (Please notify)



Relatives and Personal Friends: (Please notify)

A free Estate Planning Information Kit for Your Personal Use

Estate Planning Information

This information should be reviewed annually & updated as needed.
It should NOT be in a safety deposit box. It should be where your trusted next of kin can locate it in the event of your illness or incapacity.


This list is just a suggestion of the type of information your family will need in the event of your death or incapacity.

Full Legal Name:

Location of your birth certificate:

Nickname or Preferred Name:

Birth Date:

Social Security Number:

Location of your Social Security Card:

Any occupational licenses you have, date licensed, date it expires & where is the original certificate (or proof):

Occupation:

Estimated Annual Income from Salary, Bonuses, Etc.:

Estimated Annual Investment Income (Dividends, Interest, Etc.):

Name & Address of Your employer:

Name, title & phone number of your immediate superior:

Work Telephone:

Work Fax:

Mobile/Pager:

Email Address & password:

Home Address (Include County):

Home Telephone:

Home Fax:

Date and Place of Marriage:

Location of marriage license:

If you have lived outside Texas during this marriage, please list the states and dates of residence:

If either of you were previously married, list the dates of prior marriage, name or prior spouse, names of living children from prior marriage(s), and state whether marriage ended by death or divorce (and the location of the divorce or annulment):

Location of all annulment or divorce paperwork.

Describe any real estate owned by either or both of you outside Texas:

Location of Safe Deposit Box (if any):

Location of the Key:

Name and Telephone of Your Insurance Agent (if any):

Name and Telephone of Your Accountant (if any):

Name and Telephone of Your Broker or Financial Planner (if any):

Other Information:

Children - List their full names, date of birth, sex & their current address/phone numbers.

Grandchildren - List their full names, date of birth, sex & their current address/phone numbers.

Assets (things of value - cash, antiques, real estate, investments)

Description

Current Fair Market Value

How Is Title Held?

Where are the original of all the documents?

Bank Accounts (not IRAs and Retirement Plans)

Stocks, Bonds and Mutual Funds (not IRAs and Retirement Plans)

Closely Held Businesses, Partnerships

Real Estate

Automobiles, Boats, Etc.

Other Property

Total

If you know if the property is your separate property, your wife's separate property or community property, so state. If not, state the name(s) which appear on the title, if known, and state whether the property is held with right of survivorship, if known.

Liabilities (debts)

Description

Amount

Mortgages

Other Liabilities

Are there any outstanding legal judgments against you?

Total

Life Insurance and Annuities

Company

Insured

Beneficiary(s)

Face Amount

Cash Value

Location of all policies?

Are there any outstanding loans against any of these policies?

Total

IRAs, 401(k)s, and Other Retirement Plans

Company/Custodian

Participant

Type of Plan

Vested Amount

Death Benefit

Total

Dispositive Plan:
(Describe in general terms how you wish to leave your property at death)

Other Beneficiaries
(Information about persons other than your spouse and descendants who you wish to benefit.)

Full Name

Age

Address

Relationship to You

Fiduciaries
List name, address, home telephone and relationship to you for each person)

Executor: (The executor is the person responsible for probating the will, filing the estate tax return, and distributing assets to beneficiaries.)

First Alternate Executor:

Second Alternate Executor:

Trustee: (The trustee is the person responsible for long-term management of property for the surviving spouse, children, or other beneficiaries.)

First Alternate Trustee:

Second Alternate Trustee:

Guardian of Minor Children: (The guardian is the person who will take physical care of minor children should both parents die.)

First Alternate Guardian:

Second Alternate Guardian:

Property Agent: (The property agent is the person who will handle your financial affairs if you become incapacitated.)

First Alternate Property Agent:

Second Alternate Property Agent:

Health Care Agent: (The health care agent is the person who will make medical decisions for you if you become incapacitated.)

First Alternate Health Care Agent:

Second Alternate Health Care Agent:

DO YOU HAVE THE FOLLOWING LEGAL DOCUMENTS:

IF NOT -- YOU NEED THEM -- ESPECIALLY IF YOU ARE SINGLE - EITHER WIDOWED OR NOT LEGALLY MARRIED IN THE EYES OF THE LAW.

1. Last Will & Testiment
2. Statutory Durable Power of Attorney for Financial Decisions
3. Designation of Guardian in the Event of Later Incapacity
4. Living Will (Directive to Physician) & Family Or Surrogates
5. Agent to Control Disposition of Remains upon your Death
6. Medical Power of Attorney (in case you are unable to speak for yourself & tell the doctor what you want done)
7. Do not Resusitate Order

Power of Attorney to Act on My Behalf regarding My Minor Children

I also sell the form POWER OF ATTORNEY TO ACT ON MY BEHALF REGARDING MY MINOR CHILDREN.

The cost is $20.

Authorization to Consent to Medical Treatment of a Minor Child

I sell a form that is similar to one that I created when my own child was a minor and with a friend or relative.

The cost is $20.

I sell the legal form known as an "Answer" for Texas residents

If you have been served in a Texas civil case and need a bare-bones, basic legal document known as an ANSWER - I sell the form for $25 cash.

If you have been served with lawsuit papers in Texas that state that you need to make an appearance within 20 days the Monday next after being served, this document will work to let the Court know that you are interested in being active in the lawsuit and that the Petitioner cannot take a DEFAULT JUDGMENT against you.

Be advised that they are many variations of the legal form known as an ANSWER and this is the most basic form. If you want to file something that specifically addresses the issues alleged in the Petition, you need to hire an attorney to represent you.

You will need to take the ANSWER to the courthouse in the county that the lawsuit was filed in and "file" the document with the county clerk's office. It is free to file this document.

You will need the original document and at least 2 copies. The clerk keeps the original document and will "file stamp" the copies for you for free. Then you need to send (via hand delivery, certified mail w/ return receipt requested or fax with proof of fax received) a copy of the document to all the other parties in the lawsuit. You need to keep a copy for your files.

Fran Brochstein
713-847-6000

My new assistant - Bari

I now have an assistant to help me manage my law practice.

Her name is Bari. I am very fortunate to have her. If you need anything, please feel free to leave a message with her.

She is unable to give legal advice, but she will be glad to take down your information and get your message to me.

Fran Brochstein
713-847-6000

Free Legal Services for Indigent Texans

If you want free legal services, please contact one of the following organizations to see if you qualify for their services:

Houston Volunteer Lawyers Program

Lone Star Legal

NAACP

South Texas College of Law

University of Houston - Law Center

Texas Southern University - Law Center

The State Bar of Texas

American Bar Association

If you want discounted legal services in Harris County, try Houston Lawyer Referral Service at www.hlrs.org.

I believe all the organizations shown above are on my website at www.familylaw4u.com. Then go to FAQ and look under "Links".

Fran Brochstein
713-847-6000