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Organization Financial Affairs This quick and simple form organizes the information necessary to assist your loved one at a moment’s notice, such as banking and investment information. Ask your loved one to complete one for themselves. You can also complete one for yourself and give it to someone you trust. You may also want to consider speaking with your accountant for professional guidance, if you are considering adding yourself to your loved one’s accounts. It is also important to address some of these issues, if possible, prior to your loved one losing the capacity to give consent. If you notice that your loved one is beginning to have some memory impairment, it is a good idea to begin assisting them with their bills and banking and get this process started. 1. Sources of income:

Additional information

A

Amount

TH

IS

IS

Location (RIF, IRA, pension, 401’k, etc.)

2. Valuables (art, jewelry, etc. and their estimated values, insurance on item, etc.): ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


3. Current professional contact information Name

Notary Attorney Financial advisor Stockbroker

Phone

A

Insurance agent

Address

DE M O

Professional Accountant

IS

4. Banking Power of Attorney: Your bank/financial institution may have a specific form they need completed for another person to have financial power of attorney. Account #

Contact

Phone number

Address

TH

IS

Institution

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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5. Power of Attorney/Mandate/Durable Power of Attorney – intended for use when parent is incapacitated Prepared by: ______________________________________________ Phone number: ____________________________________________ Address: _________________________________________________ Date: ____________________________________________________ Location of original: _________________________________________ People who also have copies: (this should include your loved one’s primary physician and all people who are designated agents) ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Other: ____________________________________________________

IS

IS

A

6. Will: You should obtain a copy and put it in a safe place. a. Drafted by (name, address, phone): _____________________________________________________ _____________________________________________________ b. Drafted on date: ________________________________________ c. Location of original: _____________________________________ d. Executor contact information (name, address, phone) i. ________________________________________________ ________________________________________________ ii. ________________________________________________ ________________________________________________ iii. ________________________________________________ ________________________________________________

TH

7. Trust agreements: You should obtain a copy and put it in a safe place. a. Drafted by (name, address, phone): _____________________________________________________ _____________________________________________________ b. Drafted on date: ________________________________________ c. Location of original: _____________________________________ d. Other important details: _____________________________________________________ _____________________________________________________ _____________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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8. Location of most recent tax return: ___________________________________________________________ Accountant contact information: ___________________________________________________________ ___________________________________________________________ 9. Bank accounts:

Account # Contact Checking or Savings

Phone number

Address

Pin number

TH

IS

IS

A

Institution

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


10. Retirement, investments, pension: Address

Contact

Phone

DE M O

Account #

IS

A

Institution

11. Day to Day finances:

Amount

Account #

Phone number

IS

Institution, provider, contact

Mortgage

TH

Home insurance Rent

Phone

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


Water

Gas

Cell phone

Car

Car Insurance

Account #

Phone number

A

Electric

Amount

DE M O

Institution, provider, contact

Taxes

IS

Taxes

IS

Taxes

TH

Taxes

Credit card

Credit card

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


Institution, provider, contact

Account #

Phone number

12. Liabilities

To whom

For what

Payment details

TH

IS

IS

Money owed

A

DE M O

Loans

Amount

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


13. On-line banking or other information

Email used

Account

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Computer sign on: User name: _____________________ password: __________________ Password

Additional instructions:

TH

IS

IS

A

14. Other notes or additional instructions: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.


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