Family Document File
In the event of an emergency, whether it may be a medical emergency involving a family member, a type of emergency that requires your family to evacuate your home, or another type of emergency when you may need to access important family or personal information quickly, you should have important documents pertaining to your family gathered together in a file ready to take with you if you leave your home, or gathered for easy reference if needed. Included in this package are many forms to be filled out with personal and family information. These forms are not all- inclusive, add any additional information to your file that your family may need that you do not find in these documents. As families differ, not all forms or portions of forms may apply to your family. Fill out what does apply to your family, and as families and family situations change over time, these documents should be updated periodically to ensure the information is current.
Along with these forms, additional family documents should be included to make sure all family information is available when needed. On the following page is a list of suggestions of documents to include in your file. You may want to note where you keep your documents, if you are keeping them in a separate location than your document file, so when you need them, you know where they are located.
Additional Documents
You may want to note the location of the following documents or items
Automobile Title ______
Automotive warranty documents ______
Church records ______
Education diplomas/transcripts ______
Employment information (resume, contracts, etc.) ______
Certificates: ______
Birth, Death, Marriage, Adoption, Citizenship, etc.
Military Records ______
Passports ______
Family History Records ______
Title/Deed to house ______
Insurance Policies ______
Medical Records ______
Family Photos ______
Social Security Papers ______
Tax Returns ______
Other ______
Other ______
Family and Personal Information
Included in this section are documents relating to your personal life and personal information regarding your family members. The documents included are:
Family Member Information Sheets
Child Identification sheets – See attached file
Personal Information
Date filled out: ____/_____/______
Updated: ____/_____/______
Personal Information Husband
Full Name – Husband (First, Middle, Last, Suffix, etc.):
______
Current Address: ______
Telephone Number: (______)______
Social Security Number: ______-______-______Date of Birth :_____/______/______
Place of Birth: ______
Father’s name: ______
Mother’s maiden name: ______
Location of birth certificate: ______
Marital Status: ______Single ______Married ______Widowed ______Divorced ______Separated
Spouse’s name: ______
Spouse’s Date of Birth: ______
Any former marriages: YES NO
Children of Current Marriage (including adopted children):
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Husband Personal Information – Page 2
Children of Husband’s former Marriages (including adopted children):
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
List former addresses starting with most recent:
Number 1: ______
Dates lived at residence Number 1: ______
Number 2:______
Dates lived at residence Number 2: ______
Number 3:______
Dates lived at residence Number 3: ______
Husband’s Occupation(s):
Current Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Previous Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Previous Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Husband Personal Information – Page 3
Husband’s Education:
School Attended: ______
Degree obtained: ______
School Attended: ______
Degree obtained: ______
Husband’s Citizenship (if other than USA): ______
Have you had any Military Service: YES NO
If YES:
Service Serial Number: ______
Branch of service: ______
Dates of Service: ______
Veteran’s Administration Disability Number: ______
Location of Discharge Papers: ______
Date filled out: ____/_____/______
Updated: ____/_____/______
Personal Information -Wife
Full Name – Wife (First, Middle, Last, Suffix, etc.):
______
Current Address: ______
Telephone Number: (______)______
Social Security Number: ______-______-______Date of Birth: _____/______/______
Place of Birth: ______
Father’s name: ______
Mother’s maiden name: ______
Location of birth certificate: ______
Marital Status: ______Single ______Married ______Widowed ______Divorced ______Separated
Spouse’s name: ______
Spouse’s Date of Birth: ______
Any former marriages: YES NO
Children of Wife’s former Marriages (including adopted children):
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Wife’s Personal Information – Page 2
List former addresses starting with most recent:
Number 1: ______
Dates lived at residence Number 1: ______
Number 2: ______
Dates lived at residence Number 2: ______
Number 3: ______
Dates lived at residence Number 3: ______
Wife’s Occupation(s):
Current Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Previous Employer: ______
Date(s) of Employment: ______
Wife’s Education:
School Attended: ______
Degree obtained: ______
School Attended: ______
Degree obtained: ______
Wife’s Citizenship (if other than USA): ______
Have you had any Military Service: YES NO
If YES:
Service Serial Number: ______
Branch of service: ______
Dates of Service: ______
Veteran’s Administration Disability Number: ______
Location of Discharge Papers: ______
Date filled out: ____/_____/______
Updated: ____/_____/______
Personal Information - Other
Full Name (First, Middle, Last, Suffix, etc.):
______
Current Address: ______
Telephone Number: (______)______
Social Security Number: ______-______-______Date of Birth: _____/______/______
Place of Birth: ______
Father’s name: ______
Mother’s maiden name: ______
Location of birth certificate: ______
Marital Status: ______Single ______Married ______Widowed ______Divorced ______Separated
Spouse’s name: ______
Spouse’s Date of Birth: ______
Any former marriages: YES NO
Children of Current Marriage (including adopted children):
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Personal Information Other – Page 2
Children of former Marriages (including adopted children):
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
Name: ______
Birthdate: _____/______/______Gender: Male Female
Married: YES NO # of Children ______
List former addresses starting with most recent:
Number 1: ______
Dates lived at residence Number 1: ______
Number 2 ______
Dates lived at residence Number 2: ______
Number 3: ______
Dates lived at residence Number 3: ______
Other - Personal Information – Page 3
Occupation(s):
Current Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Previous Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Previous Employer: ______
Date(s) of Employment: ______
Position(s) held: ______
Education:
School Attended: ______
Degree obtained: ______
School Attended: ______
Degree obtained: ______
Citizenship (if other than USA): ______
Have you had any Military Service: YES NO
If YES:
Service Serial Number: ______
Branch of service: ______
Dates of Service: ______
Veteran’s Administration Disability Number: ______
Location of Discharge Papers: ______
Financial and Legal Information
Included in this section are documents relating to your financial information and the financial information of your family. The documents include:
Banking Information
Checking, Savings, Money Market, CDs,
Marketable Securities
Mortgage Information
Insurance Information
Life Insurance
Automobile Insurance
Homeowner’s Insurance
Personal Property Inventory
Will & Trust Information
Power of Attorney
Tax Return Information
Creditors and debtors
Banking Information
Date filled out: ____/_____/______
Updated: ____/_____/______
Checking account(s):
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Savings account(s):
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Savings account(s) continued:
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Investment or Money Market Account(s):
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Certificates of Deposit(s):
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on CD: ______
Bank Name: ______
Address: ______
Account Number: ______
Name(s) on CD: ______
Credit Union Account(s):
Credit Union Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Credit Union Account(s) con’t:
Credit Union Name: ______
Address: ______
Account Number: ______
Name(s) on account: ______
Retirement Account(s) Employee Benefits:
Individual Retirement Account:
Owner: ______
Beneficiary: ______
Value: ______
Individual Retirement Account:
Owner: ______
Beneficiary: ______
Value: ______
401(k), 403(b) Plans
Owner: ______
Beneficiary: ______
Value: ______
Tax Deferred Annuity
Owner: ______
Beneficiary: ______
Value: ______
Qualified Pension, KEOGH, or Profit Sharing
Owner: ______
Beneficiary: ______
Value: ______
Stock Option or Thrift Plan:
Owner: ______
Beneficiary: ______
Value: ______
Other: (Deferred Compensation, Roth IRA, Insurance Policies, Disability Policies, Long Term Care Insurance Policies, etc.)
Owner: ______
Beneficiary: ______
Value: ______
Owner: ______
Beneficiary: ______
Value: ______
Marketable Securites
Company: ______
Type: ______
Owner: ______
# of Shares: ______Original Cost: $______Current Value$______
Company: ______
Type: ______
Owner: ______
# of Shares: ______Original Cost: $______Current Value$______
Home Mortgage Information
Date filled out: ____/_____/______
Updated: ____/_____/______
Mortgage/Lending Institution Name: ______
Address: ______
Account/Loan Number: ______
Name(s) on account/loan: ______
Monthly Payment Amount: $______
Original Loan Amount $______
Payment due date of each month: ______
Additional Mortgage (Second Mortgage):
Mortgage/Lending Institution Name: ______
Address: ______
Account/Loan Number: ______
Name(s) on account/loan: ______
Monthly Payment Amount: $______
Original Loan Amount $______
Payment due date of each month: ______
Insurance Information
Life Insurance
Date filled out: ____/_____/______
Updated: ____/_____/______
Company: ______
Name of Insured: ______
Owner: ______
Primary Beneficiary: ______
Contingent Beneficiary: ______
Policy Number: ______
Death Benefit: ______
Company: ______
Name of Insured: ______
Owner: ______
Primary Beneficiary: ______
Contingent Beneficiary: ______
Policy Number: ______
Death Benefit: ______
Others holding insurance on your life:
Company:
Name of Insured: ______
Owner: ______
Primary Beneficiary: ______
Contingent Beneficiary: ______
Policy Number: ______
Death Benefit: ______
Automobile Insurance
Date filled out: ____/_____/______
Updated: ____/_____/______
Vehicle #1:
Make and Model: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Vehicle #2
Company Name: ______
Policy Number: ______
Location of Policy: ______
Vehicle #3
Company Name: ______
Policy Number: ______
Location of Policy: ______
Other Policies(Boat, Trailer, Theft, Liability, Long-term care, etc.)
Type: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Type: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Homeowner’s Insurance
Date filled out: ____/_____/______
Updated: ____/_____/______
Primary Residence:
Property Address: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Secondary Residence:
Property Address: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Other:
Property Address: ______
Company Name: ______
Policy Number: ______
Location of Policy: ______
Personal Property Inventory
List all items of value you own, the item’s location, value, and description you can provide. You should also take pictures of your items or record their image on video. This information will be important for insurance purposes should anything happen to these items.
Date filled out: ____/_____/______
Updated: ____/_____/______
Furniture:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Vehicle(s):
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Jewelry:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Electronics:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Clothing:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Antiques:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Dishes, China, Silervare, Cookware:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Tools, Equipment, Outdoor items, bicycles, etc.:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Other:
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Item: ______Value: ______
Description: ______
Will & Trust Information
Date filled out: ____/_____/______
Updated: ____/_____/______
LIVING WILL DECLARATION OF ______To my family, doctors, hospitals, surgeons, medical care providers, and all others concerned with my care:
I, ______, being of sound mind and rational thought, willfully and voluntarily make this declaration to be followed if I become incompetent or incapacitated to the extent that I am unable to communicate my wishes, desires and preferences on my own.
This declaration reflects my firm, informed, and settled commitment to refuse life-sustaining medical care and treatment under the circumstances that are indicated below.
This declaration and the following directions are an expression of my legal right to refuse medical care and treatment. I expect and trust the above-mentioned parties to regard themselves as legally and morally bound to act in accordance with my wishes, desires, and preferences. The above-mentioned parties should therefore be free from any legal liabilities for having followed this declaration and the directions that it contains.