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Appendix I
How to Calculate Your Estate Tax Liability

  1. Calculate the value of your gross estate (fair market value of assets at time of death): liquid assets, investments and other. For insurance, use face value amount of term and whole life insurance.
  2. Determine adjusted gross estate. Subtract last expense deductions from gross estate: taxes, last illness and funeral expenses, debts, casualty losses and estate settlement costs.
  3. Determine taxable estate. Subtract estate planning deductions from adjusted gross estate. Estate planning deductions include the fair market value of charitable contributions and the marital deduction, the amount left outright to the surviving spouse.
  4. Calculate the tentative estate tax liability. Use the estate tax table. Find taxable estate amount. Calculate additional tax and add to amount in your taxable transfer range
  5. Determine estate tax liability. Subtract unified credit if available. The unified credit is $220,550 equivalent to a taxable estate of $675,000
  6. Determine estate tax liability. Subtract unified credit from tentative estate tax liability.

Table 1-1. Estate and Gift Tax Rate Schedules

A

B

C

D

Taxable transfer ranges
Amount subject to tentative tax

Tax on amount in Column A

Tax rate on excess over amounts in Column A

Exceeding

But not exceeding

Percent

$ Ń
10,000
20,000
40,000
60,000
80,000
100,000
150,000
250,000
500,000
750,000
1,000,000
1,250,000
1,500,000
2,000,000
2,500,000
3,000,000

$ 10,000
20,000
40,000
60,000
80,000
100,000
150,000
250,000
500,000
750,000
1,000,000
1,250,000
1,500,000
2,000,000
2,500,000
3,000,000
Ń

$ Ń
1,800
3,800
8,200
13,000
18,200
23,800
38,800
70,800
155,800
248,300
345,800
448,300
555,800
780,800
1,025,800
1,290,800

18
20
22
24
26
28
30
32
34
37
39
41
43
45
49
53
55

If you make gifts or die after 1987, there is an additional 5 percent tax on estates in the range of $10 million to $21.4 million.

*Source: Leimberg, 1995, 585.


Estate Tax Liability Computation

Assets

Spouse 1

Spouse 2

Combined

1. Total assets to calculate value of gross estate.

Liquid assets

     

Life insurance face value (term and whole)

     

Cash on hand and in bank

     

Checking accounts

     

Savings accounts

     

Money market accounts

     

Certificates of deposit

     

Savings bonds

     

Investments

     

Stocks

     

Corporate bonds

     

Government/municipal bonds

     

Mutual funds

     

Retirement plans

     

Other

     

Real property

     

Farm assets

     

Business assets

     

Personal property

     

Gross estate

     

2. Subtract last expense deductions from gross estate to determine adjusted gross estate.

Taxes due at death or before settlement

     

Last illness and funeral expenses

     

Debts and claims against estate

     

Qualified casualty losses not covered by insurance

     

Administration cost of estate settlement

     

Total last expense deduction

     

Gross estate

     

Last expense deduction (minus)

     

Adjusted gross estate

     

3. Subtract estate planning deductions from adjusted gross estate to determine taxable estate.

Charitable transfers

     

Marital deduction

     

Total estate planning deductions

     

Adjusted gross estate

     

Total estate planning deduction (minus)

     

Taxable estate

     

4. Calculate tentative estate tax liability.

     

a. Taxable estate

     

b. Taxable transfer range (from Table 1-1)

     

c. Tax for range

     

d. Amount over range

     

e. Transfer tax bracket (%)

     

f. Multiply amount over range by the transfer tax percentage (steps d and e).

     

g. Add steps c and f to get tentative estate tax liability.

     

5. Subtract unified credit exemption ($220,550) if you haven't previously used it.

     

6. Determine estate tax liability. Subtract Step 5 from Step 4g.

     

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Appendix II
The Georgia Living Will

  1. Any competent adult may execute a document directing that, should the declarant have a terminal condition, life-sustaining procedures be withheld or withdrawn. Such living will shall be signed by the declarant in the presence of at least two competent adults who, at the time of the execution of the living will, to the best of their knowledge:
    1. are not related to the declarant by blood or marriage;
    2. would not be entitled to any portion of the estate of the declarant upon the declarant's decease under any testamentary will of the declarant, or codicil thereto, and
    3. would not be entitled to any such portion by operation of law under the rules of descent and distribution of this state at the time of the execution of the living will;
    4. are neither the attending physician nor an employee of the attending physician nor an employee of the hospital or skilled nursing facility in which the declarant is a patient;
    5. are not directly financially responsible for the declarant's medical care; and
    6. do not have a claim against any portion of the estate of the declarant.
  2. The declaration shall be a document, separate and self-contained. Any declaration that constitutes an expression of the declarant's intent shall be honored, regardless of the form used or when executed. Declarations executed on or after March 28, 1986, shall be valid indefinitely unless revoked. A declaration similar to the following form or in substantially the form specified under prior law shall be presumed on its face to be valid and effective.

Living Will

Living will made this ___________ day of , ____________________________, ________(month, year).

I, ______________________________________________, being of sound mind, willfully and voluntarily make known my desire that my life shall not be prolonged under the circumstances set forth below and do declare:

1. If at any time I should (check each option desired):

( ) have a terminal condition,

( ) become in a coma with no reasonable expectation of regaining consciousness, or

( ) become in a persistent vegetative state with no reasonable expectation of regaining significant cognitive function,

as defined in and established in accordance with the procedures set forth in paragraphs (2), (9), and (13) of Code Section 31-32-2 of the Official Code of Georgia Annotated, I direct that the application of life-sustaining procedures to my body (check the option desired):

( ) including nourishment and hydration;

( ) including nourishment but not hydration, or

( ) excluding nourishment and hydration,

be withheld or withdrawn and that I be permitted to die;

2. In the absence of my ability to give directions regarding the use of such life-sustaining procedures, it is my intention that this living will shall be honored by my family and physician(s) as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal;

3. I understand that I may revoke this living will at any time;

4. I understand the full import of this living will, and I am at least 18 years of age, and am emotionally and mentally competent to make this living will; and

5. If I am a female and I have been diagnosed as pregnant, this living will shall have no force and effect unless the fetus is not viable and I indicate by initialing after this sentence that I want this living will to be carried out.
(Initial)

Signed: ___________________________________________________________

____________________________________ (Residence) ___________________ (City) and

____________________________________ (County), and _________________ (State)


I hereby witness this living will and attest that:

1. The declarant is personally known to me and I believe the declarant to be at least 18 years of age and of sound mind;

2. I am at least 18 years of age;

3. To the best of my knowledge, at the time of the execution of this living will, I:

A. Am not related to the declarant by blood or marriage;
B. Would not be entitled to any portion of the declarant's estate by any will or by operation of law under the rules of descent and distribution of this state;
C. Am not the attending physician of declarant or an employee of the attending physician or an employee of the hospital or skilled nursing facility in which the declarant is a patient;
D. Am not directly financially responsible for the declarant's medical care; and
E. Have no present claim against any portion of the estate of the declarant;

4. Declarant has signed this document in my presence as above instructed, on the date above first shown.


Witness ___________________________________________________________

Address ___________________________________________________________

Witness ___________________________________________________________

Address ___________________________________________________________

Additional witness required when living will is signed in a hospital or skilled nursing facility.

I hereby witness this living will and attest that I believe the declarant to be of sound mind and to have made this living will willingly and voluntarily.

Witness: ___________________________________________________________

Medical director of skilled nursing facility or staff physician not participating in care of the patient or chief of the hospital medical staff or staff physician or hospital designee not participating in care of the patient.

 

This is a replication of the Living Will form as found in the Georgia Code §31-32-3 as of March 17, 1999. It is provided to the people of Georgia for their education and information and is not intended as legal advice.

Please check with a lawyer to make sure the law has not changed or if you have any questions.

Eleanor M. Crosby, J.D., M.A., Georgia Senior Hot Line


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Appendix III
The Georgia Durable Power of Attorney for Health Care

Notice: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR AGENT) BROAD POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU, INCLUDING POWER TO REQUIRE, CONSENT TO, OR WITHDRAW ANY TYPE OF PERSONAL CARE OR MEDICAL TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO ADMIT YOU TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME, OR OTHER INSTITUTION; BUT NOT INCLUDING PSYCHOSURGERY, STERILIZATION, OR INVOLUNTARY HOSPITALIZATION OR TREATMENT COVERED BY TITLE 37 OF THE OFFICIAL CODE OF GEORGIA ANNOTATED. THIS FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT, WHEN A POWER IS EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS FORM. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU MAY NAME COAGENTS AND SUCCESSOR AGENTS UNDER THIS FORM, BUT YOU MAY NOT NAME A HEALTH CARE PROVIDER WHO MAY BE DIRECTLY OR INDIRECTLY INVOLVED IN RENDERING HEALTH CARE TO YOU UNDER THIS POWER. UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER IN THE MANNER PROVIDED BELOW OR UNTIL YOU REVOKE THIS POWER OR A COURT ACTING ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY EXERCISE THE POWERS GIVEN IN THIS POWER THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME DISABLED, INCAPACITATED, OR INCOMPETENT. THE POWERS YOU GIVE YOUR AGENT, YOUR RIGHT TO REVOKE THOSE POWERS, AND THE PENALTIES FOR VIOLATING THE LAW ARE EXPLAINED MORE FULLY IN CODE SECTIONS 31-36-6, 31-36-9, AND 31-36-10 OF THE GEORGIA ŌDURABLE POWER OF ATTORNEY FOR HEALTH CARE ACTÕ OF WHICH THIS FORM IS A PART. THAT ACT EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF POWER OF ATTORNEY YOU MAY DESIRE. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.

DURABLE POWER OF ATTORNEY made this __________ day of ______________, 20_____.

1. I, _________________________________________________________________________________
(insert name and address of principal)

hereby appoint ______________________________________________________________________
(insert name and address of agent)

as my attorney in fact (my agent) to act for me and in my name in any way I could act in person to make any and all decisions for me concerning my personal care, medical treatment, hospitalization, and health care and to require, withhold, or withdraw any type of medical treatment or procedure, even though my death may ensue. My agent shall have the same access to my medical records that I have, including the right to disclose the contents to others. My agent shall also have full power to make a disposition of any part or all of my body for medical purposes, authorize an autopsy of my body, and direct the disposition of my remains.

THE ABOVE GRANT OF POWER IS INTENDED TO BE AS BROAD AS POSSIBLE SO THAT YOUR AGENT WILL HAVE AUTHORITY TO MAKE ANY DECISION YOU COULD MAKE TO OBTAIN OR TERMINATE ANY TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF NOURISHMENT AND FLUIDS AND OTHER LIFE-SUSTAINING OR DEATH-DELAYING MEASURES, IF YOUR AGENT BELIEVES SUCH ACTION WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU WISH TO LIMIT THE SCOPE OF YOUR AGENTÕS POWERS OR PRESCRIBE SPECIAL RULES TO LIMIT THE POWER TO MAKE AN ANATOMICAL GIFT, AUTHORIZE AUTOPSY, OR DISPOSE OF REMAINS, YOU MAY DO SO IN THE FOLLOWING PARAGRAPHS.

2. The powers granted above shall not include the following powers or shall be subject to the following rules or limitations (here you may include any specific limitations you deem appropriate, such as your own definition of when life-sustaining or death-delaying measures should be withheld; a direction to continue nourishment and fluids or other life-sustaining or death-delaying treatment in all events; or instructions to refuse any specific types of treatment that are inconsistent with your religious beliefs or unacceptable to you for any other reason, such as blood transfusion, electroconvulsive therapy, or amputation):

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

THE SUBJECT OF LIFE-SUSTAINING OR DEATH-DELAYING TREATMENT IS OF PARTICULAR IMPORTANCE. FOR YOUR CONVENIENCE IN DEALING WITH THAT SUBJECT, SOME GENERAL STATEMENTS CONCERNING THE WITHHOLDING OR REMOVAL OF LIFE-SUSTAINING OR DEATH-DELAYING TREATMENT ARE SET FORTH BELOW. IF YOU AGREE WITH ONE OF THESE STATEMENTS, YOU MAY INITIAL THAT STATEMENT, BUT DO NOT INITIAL MORE THAN ONE:

I do not want my life to be prolonged nor do I want life-sustaining or death-delaying treatment to be provided or continued if my agent believes the burdens of the treatment outweigh the expected benefits. I want my agent to consider the relief of suffering, the expense involved, and the quality as well as the possible extension of my life in making decisions concerning life-sustaining or death-delaying treatment.

Initialed__________________

I want my life to be prolonged and I want life-sustaining or death-delaying treatment to be provided or continued unless I am in a coma, including a persistent vegetative state, which my attending physician believes to be irreversible, in accordance with reasonable medical standards at the time of reference. If and when I have suffered such an irreversible coma, I want life-sustaining or death-delaying treatment to be withheld or discontinued.

Initialed__________________

I want my life to be prolonged to the greatest extent possible without regard to my condition, the chances I have for recovery, or the cost of the procedures.

Initialed__________________

THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY YOU AT ANY TIME AND IN ANY MANNER WHILE YOU ARE ABLE TO DO SO. IN THE ABSENCE OF AN AMENDMENT OR REVOCATION, THE AUTHORITY GRANTED IN THIS POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS POWER IS SIGNED AND WILL CONTINUE UNTIL YOUR DEATH AND WILL CONTINUE BEYOND YOUR DEATH IF ANATOMICAL GIFT, AUTOPSY, OR DISPOSITION OF REMAINS IS AUTHORIZED, UNLESS A LIMITATION ON THE BEGINNING DATE OR DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR BOTH OF THE FOLLOWING:

3. ( ) This power of attorney shall become effective on _______________________________________(insert a future date or event during your lifetime, such as court determination of your disability, incapacity, or incompetency, when you want this power to first take effect).

4. ( ) This power of attorney shall terminate on _____________________________________________(insert a future date or event, such as court determination of your disability, incapacity, or incompetency, when you want this power to terminate prior to your death).

IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAMES AND ADDRESSES OF SUCH SUCCESSORS IN THE FOLLOWING PARAGRAPH:

5. If any agent named by me shall die, become legally disabled, incapacitated, or incompetent, or resign, refuse to act, or be unavailable, I name the following (each to act successively in the order named) as successors to such agent:

___________________________________________________________________________________________

___________________________________________________________________________________________

IF YOU WISH TO NAME A GUARDIAN OF YOUR PERSON IN THE EVENT A COURT DECIDES THAT ONE SHOULD BE APPOINTED, YOU MAY, BUT ARE NOT REQUIRED TO, DO SO BY INSERTING THE NAME OF SUCH GUARDIAN IN THE FOLLOWING PARAGRAPH. THE COURT WILL APPOINT THE PERSON NOMINATED BY YOU IF THE COURT FINDS THAT SUCH APPOINTMENT WILL SERVE YOUR BEST INTERESTS AND WELFARE. YOU MAY, BUT ARE NOT REQUIRED TO, NOMINATE AS YOUR GUARDIAN THE SAME PERSON NAMED IN THIS FORM AS YOUR AGENT.

6. If a guardian of my person is to be appointed, I nominate the following to serve as such guardian:

___________________________________________________________________________________________
(insert name and address of nominated guardian of the person)

7. I am fully informed as to all the contents of this form and understand the full import of this grant of powers to my agent.

Signed ___________________________________________________
(Principal)

The principal has had an opportunity to read the above form and has signed the above form in our presence. We, the undersigned, each being over 18 years of age, witness the principalÕs signature at the request and in the presence of the principal, and in the presence of each other, on the day and year above set out.

Witnesses: Addresses:
_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________
_____________________________________________ _____________________________________________

Additional witness required when health care agency is signed in a hospital or skilled nursing facility.

I hereby witness this health care agency and attest that I believe the principal to be of sound mind and to have made this health care agency willingly and voluntarily.

Witness: ___________________________________________________
Attending Physician

Address: ___________________________________________________

___________________________________________________

YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND SUCCESSOR AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW. IF YOU INCLUDE SPECIMEN SIGNATURES IN THIS POWER OF ATTORNEY, YOU MUST COMPLETE THE CERTIFICATION OPPOSITE THE SIGNATURES OF THE AGENTS.

Specimen signatures of agent and successor(s) I certify that the signature of my agent and successor(s) is correct.:

_____________________________________________
(Agent)

_____________________________________________
(Principal)

_____________________________________________
(Successor Agent)

_____________________________________________
(Principal)


_____________________________________________
(Successor Agent)


_____________________________________________
(Principal)

b. The foregoing statutory health care power of attorney form authorizes, and any different form of health care agency may authorize, the agent to make any and all health care decisions on behalf of the principal which the principal could make if present and under no disability, incapacity, or incompetency, subject to any limitations on the granted powers that appear on the face of the form, to be exercised in such manner as the agent deems consistent with the intent and desires of the principal. The agent will be under no duty to exercise granted powers or to assume control of or responsibility for the principalÕs health care; but, when granted powers are exercised, the agent will be required to use due care to act for the benefit of the principal in accordance with the terms of the statutory health care power and will be liable for negligent exercise. The agent may act in person or through others reasonably employed by the agent for that purpose buy may not delegate authority to make health care decisions. The agent may sign and deliver all instruments, negotiate and enter into all agreements, and do all other acts reasonably necessary to implement the exercise of the powers granted to the agent. Without limiting the generality of the foregoing, the statutory health care power form shall, and any different form of health care agency may, include the following powers, subject to any limitations appearing on the face of the form:

  1. The agent is authorized to consent to and authorize or refuse or to withhold or withdraw consent to, any and all types of medical care, treatment, or procedures relating to the physical or mental health of the principal, including any medication program, surgical procedures, life-sustaining or death-delaying treatment, or provision of nourishment and fluids for the principal, but not including psychosurgery, sterilization, or involuntary hospitalization or treatment covered by Title 37;
  2. The agent is authorized to admit the principal to or discharge the principal from any and all types of hospitals, institutions, homes, residential or nursing facilities, treatment centers, and other health care institutions providing personal care or treatment for any type of physical or mental condition, but not including psychosurgery, sterilization, or involuntary hospitalization or treatment covered by Title 37;
  3. The agent is authorized to contract for any and all types of health care services and facilities in the name of and on behalf of the principal and to bind the principal to pay for all such services and facilities, and the agent shall not be personally liable for any services or care contracted for on behalf of the principal;
  4. At the principalÕs expense and subject to reasonable rules of the health care provider to prevent disruption of the principalÕs health care, the agent shall have the same right the principal has to examine and copy and consent to disclosure of all the principalÕs medical records that the agent deems relevant to the exercise of the agentÕs powers, whether the records relate to mental health or any other medical condition and whether they are in the possession of or maintained by any physician, psychiatrist, psychologist, therapist, hospital, nursing home, or other health care provider, notwithstanding the provisions of any statute or other rule of law to the contrary; and
  5. The agent is authorized to direct that an autopsy of the principalÕs body be made; to make a disposition of any part or all of the principalÕs body pursuant to Article 6 of Chapter 5 of Title 44, the "Georgia Anatomical Gift Act," as now or hereafter amended; and to direct the disposition of the principalÕs remains.


This is a replication of the Durable Power of Attorney for Health Care in the Georgia Code ¤31-36-10 as of March 17, 1999. It is provided to the people of Georgia for their education and information and is not intended for legal advice.

Please check with a lawyer to make sure the law has not changed or if you have any questions.

Eleanor M. Crosby, JD, MA, Georgia Senior Hot Line


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Appendix IV
Financial Power of Attorney

County of __________________________
State of Georgia

I, ___________________________________________, (hereinafter "principal"), a resident of _________________________________ County, Georgia, do hereby constitute and appoint_________________________________ my true and lawful attorney-in-fact (hereinafter "Agent") for me and give such person the power(s) specified below to act in my name, place, and stead in any way which I, myself, could do if I were personally present with respect to the following matters:

Directions: To give the Agent the powers described in paragraphs 1 through 13, place your initials on the blank line at the end of each paragraph. If you DO NOT want to give a power to the Agent, strike through the paragraph or a line within the paragraph and place your initials beside the stricken paragraph or stricken line. The powers described in any paragraph not initialed or which has been struck through will not be conveyed to the Agent. Both the Principal and the Agent must sign their full names at the end of the last paragraph.)

  1. Bank and Credit Union Transactions: To make, receive, sign, endorse, execute, acknowledge, deliver, and possess checks, drafts, bills of exchange, letters of credit, notes, stock certificates, withdrawal receipts and deposit instruments relating to accounts or deposits in, or certificates of deposit of banks, savings and loans, credit unions, or other institutions or associations. __________
  2. Payment Transactions: To pay all sums of money, at any time or times, that may hereafter be owing by me upon any account, bill or exchange, check, draft, purchase, contract, note, or trade acceptance made, executed, endorsed, accepted, and delivered by me or for me in my name, by my Agent.
    ___________

Note: If you initial paragraph 3 or paragraph 4 that follow, a notarized signature will be required on behalf of the Principal.

  1. Real Property Transactions: To lease, sell, mortgage, purchase, exchange, and acquire, and to agree, bargain, and contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any interest in real property whatsoever, on such terms and conditions, and under such covenants, as my Agent shall deem proper; and to maintain, repair, tear down, alter, rebuild, improve, manage, insure, move, rent, lease, sell, convey, subject to liens, mortgages, and security deeds, and in any way or manner deal with all or any part of any interest in real property whatsoever, including specifically, but without limitation, real property lying and being situate in the State of Georgia, under such terms and conditions, and under such covenants, as my Agent shall deem proper and may for all deferred payments accept purchase money notes payable to me and secured by mortgages or deeds to secure debt, and may from time to time collect and cancel any of said notes, mortgages, security interests, or deeds to secure debt. ___________
  2. Personal Property Transactions: To lease, sell, mortgage, purchase, exchange, and acquire, and to agree, bargain, and contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any personal property whatsoever, tangible or intangible, or interest thereto, on such terms and conditions, and under such covenants, as my Agent shall deem proper; and to maintain, repair, improve, manage, insure, rent, lease, sell, convey, subject to liens or mortgages, or to take any other security interests in said property which are recognized under the Uniform Commercial Code as adopted at that time under the laws of Georgia or any applicable state, or otherwise hypothecate, and in any way or manner deal with all or any part of any real or personal property whatsoever, tangible or intangible, or any interest therein, that I own at the time of execution or may thereafter acquire, under such terms and conditions, and under such covenants, as my Agent shall deem proper. ___________
  3. Stock and Bond Transactions: To purchase, sell, exchange, surrender, assign, redeem, vote at any meeting, or otherwise transfer any and all shares of stock, bonds, or other securities in any business, association, corporation, partnership, or other legal entity, whether private or public, now or hereafter belonging to me. ___________
  4. Safe Deposits: To have free access at any time or times to any safe deposit box or vault to which I might have access. ___________
  5. Borrowing: To borrow from time to time such sums of money as my Agent may deem proper and execute promissory notes, security deeds or agreements, financing statements, or other security instruments in such form as the lender may request and renew said notes and security instruments from time to time in whole or in part. ___________
  6. Business Operating Transactions: To conduct, engage in, and otherwise transact the affairs of any and all lawful business ventures of whatever nature or kind that I may now or hereafter be involved in. ___________
  7. Insurance Transactions: To exercise or perform any act, power, duty, right, or obligation, in regard to any contract of life, accident, health, disability, liability, or other type of insurance or any combination of insurance; and to procure new or additional contracts of insurance for me and to designate the beneficiary of same; provided, however, that my Agent cannot designate himself or herself as beneficiary of any such insurance contracts. ___________
  8. Disputes and Proceedings: To commence, prosecute, discontinue, or defend all actions or other legal proceedings touching my property, real or personal, or any part thereof, or touching any matter in which I or my property, real or personal, may be in any way concerned. To defend, settle, adjust, make allowances, compound, submit to arbitration, and compromise all accounts, reckonings, claims, and demands whatsoever that now are, or hereafter shall be, pending between me and any person, firm, corporation, or other legal entity, in such manner and in all respects as my Agent shall deem proper. ___________
  9. Hiring Representatives: To hire accountants, attorneys at law, consultants, clerks, physicians, nurses, agents, servants, workmen and others and to remove them, and to appoint others in their place, and to pay and allow the persons so employed such salaries, wages, or other remunerations, as my Agent shall deem proper. ___________
  10. Tax, Social Security, and Unemployment: To prepare, to make elections, to execute and to file all tax, social security, unemployment insurance, and informational returns required by the laws of the United States or of any state or subdivision thereof, or of any foreign government; to prepare, to execute, and to file all other papers and instruments which the Agent shall think to be desirable or necessary for safeguarding of me against excess or illegal taxation or against penalties imposed for claimed violation of any law or other governmental regulation; and to pay, to compromise, or to contest or to apply for refunds in connection with any taxes or assessments for which I am or may be liable. ___________
  11. Broad Powers: Without, in any way, limiting the foregoing, generally to do, execute, and perform any other act, deed, matter, or thing whatsoever, that should be done, executed, or performed, including, but not limited to, powers conferred by Code Section 53-12-232 of the Official Code of Georgia Annotated, or that in the opinion of my Agent, should be done, executed, or performed, for my benefit or the benefit of my property, real or personal, and in my name of every nature and kind whatsoever, as fully and effectually as I could do if personally present. ___________
  12. Effective Date: This document will become effective upon the date of the PrincipalÕs signature unless the Principal indicates that it should become effective at a later date by completing the following, which is optional. ___________

The powers conveyed in this document shall not become effective until the following time or upon the occurrence of the following event or contingency:

Note: The Principal may choose to designate one or more persons to determine conclusively that the above-specified event or contingency has occurred. Such person or persons must make a written declaration under penalty of false swearing that such event or contingency has occurred in order to make this document effective. Completion of this provision is optional.

The following person or persons are designated to determine conclusively that the above-specified event or contingency has occurred:

________________________________________________________________________________________

________________________________________________________________________________________

Signed: ___________________________________
Principal

___________________________________
Agent

It is my desire and intention that this power of attorney shall not be affected by my subsequent disability, incapacity, or mental incompetence. Any and all acts done by the Agent pursuant to the powers conveyed herein during any period of my disability or incapacity shall have the same force and effect as if I were competent and not disabled.

I may, at any time, revoke this power of attorney, but it shall be deemed to be in full force and effect as to all persons, institutions, and organizations which shall act in reliance thereon prior to the receipt of written revocation thereof signed by me and prior to receipt of actual notice of my death.

I do hereby ratify and confirm all acts whatsoever which my Agent shall do, or cause to be done, in or about the premises, by virtue of this power of attorney.

All parties dealing in good faith with my Agent may fully rely upon the power of and authority of my Agent to act for me on my behalf and in my name, and may accept and rely on agreements and other instruments entered into or executed by the agent pursuant to this power of attorney.

This instrument shall not be effective as a grant of powers to my Agent until my Agent has executed the Acceptance of Appointment appearing at the end of this instrument. This instrument shall remain effective until revocation by me or my death, whichever occurs first.

Compensation of Agent. (Directions: Initial the line following your choice.)

  1. My Agent shall receive no compensation for services rendered. ______________
  2. My Agent shall receive reasonable compensation for services rendered. ______________
  3. My Agent shall receive $__________________ for services rendered. ______________

IN WITNESS WHEREOF, I have hereunto set my hand and seal on this ______ Day of ____________, 20___.

___________________________________
Principal

WITNESSES

___________________________________
Signature and Address

___________________________________
Signature and Address

Note: A notarized signature is not required unless you have initialed paragraph 3 or 4 regarding property transactions.

I, ____________________________________________________, a Notary Public, do hereby certify that _______________________________ personally appeared before me this date and acknowledged the due execution of the foregoing Power of Attorney.

___________________________________
Notary Public

State of Georgia
County of _______________

Acceptance of Appointment

I, (print name), have read the foregoing Power of Attorney and am the person identified therein as Agent for _____________________________ (name of grantor of power of attorney), the Principal named therein. I hereby acknowledge the following:

I owe a duty of loyalty and good faith to the Principal, and must use the powers granted to me only for the benefit of the Principal.

I must keep the PrincipalÕs funds and other assets separate and apart from my funds and other assets and titled in the name of the Principal. I must not transfer title to any of the PrincipalÕs funds or other assets into my name alone. My name must not be added to the title of any funds or other assets of the Principal, unless I am specifically designated as Agent for the Principal in the title.

I must protect and conserve, and exercise prudence and caution in my dealings with, the PrincipalÕs funds and other assets.

I must keep a full and accurate record of my acts, receipts, and disbursements on behalf of the Principal, and be ready to account to the Principal for such acts, receipts, and disbursements at all times. I must provide an annual accounting to the Principal of my acts, receipts, and disbursements, and must furnish an accounting of such acts, receipts, and disbursements to the personal representative of the PrincipalÕs estate within 90 days after the date of death of the Principal.

I have read the Compensation of Agent paragraph in the Power of Attorney and agree to abide by it.

I acknowledge my authority to act on behalf of the Principal ceases at the death of the Principal.

I hereby accept the foregoing appointment as Agent for the Principal with full knowledge of the responsibilities imposed on me, and I will faithfully carry out my duties to the best of my ability.

Dated: _____________, 20_____

___________________________________
(Signature)

___________________________________
(Address)

Note: A notarized signature is not required unless the Principal initialed paragraph 3 or paragraph 4 regarding property transactions.

I, ___________________________________, a Notary Public, do hereby certify that ___________________________________ personally appeared before me this date and acknowledge the due execution of the foregoing Acceptance of Appointment.

___________________________________
Notary Public


This is a replication of the Financial Power of Attorney in the Georgia Code 10-6-142 as of March 17, 1999. It is provided to the people of Georgia for their education and information and is not intended as legal advice.

Please check with a lawyer to make sure the law has not changed or if you have any questions.

Eleanor M. Crosby, JD, MA, Georgia Senior Hot line


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Appendix V
What to Do When Your Loved One Dies

When your spouse or someone close to you dies, certain things need to be done. Here is a quick list of things to do:

1. Contact the funeral director. Be prepared to give the following information for the death certificate.

____ full name of deceased
____ date and place of birth
____ nationality
____ occupation
____
Social Security number
____ marital status
____ full name of parents, siblings, and other survivors of deceased (including mother's maiden name)
____ full name of previous marriage partner(s)

Make funeral arrangements with funeral director and clergy.

____ specify when family members will be available
____ select casket
____ select calling hours
____ choose cremation, body donation, memorial service and burial service
____
select transportation (number of cars, limousines)

Full expenses may include coffin, flowers, clergy, honorariums, newspaper notices, use of church, clothing, transportation, funeral home space rental, certified death transcripts, opening the grave, cemetery plot, grave marker and cremation.

2. Contact clergyman.
____ specify when family members will arrive
____ plan service including hymns and poems
____ provide biographical information
____ ask his choice of time for services

3. Contact attorney immediately so he or she can:

____ locate and probate will*
____ advise you as to what to sign and what not to sign
____ re-record deeds to real property*
____ disperse estate assets such as stocks, bonds, savings accounts, business assets*
____ write a will for you or review and update your will
____ advise you

*Some choose to do this themselves

4. Locate cash to take care of immediate needs. Sources of cash include:

____ cash on hand
____ savings accounts
____ checking accounts
____ money market certificates
____ life insurance cash value

5. Likely places to search for important papers are:

____ safe deposit boxes
____ brief cases
____ strong boxes
____ office desk
____ lockers
____ safes

Locate:

____ life insurance policies
____ accidental death and health insurance policies
____ homeowner insurance polices
____ bankbooks
____ notes receivable and notes payable
____ real estate deeds
____ security certificates
____ wills
____ income tax return forms
____ W-2 forms and other records of earnings
____ marriage certificate
____ Social Security number
____ birth certificates of all family members to prove ages
____ military discharge papers
____ Veterans Administration claim number
____ automobile registration
____ installment payment books

6. Obtain copies of these papers:

____ death certificate (need at least 15 copies from funeral director to claim insurance, Social Security and veterans benefits)
____ birth certificate
____ marriage certificate
____ Social Security card

7. Contact life insurance agents.

____ file a claim using death certificate or attending physician's statement for proof of death
____ supply information including policy number(s) and amount(s), full name and address of deceased, deceased's occupation and date last worked, date and place of birth, date, place and cause of death, claimant's name, age, address and Social Security number

Your settlement options are:

____ lump sum Š you may immediately be paid a lump sum
____ interest only Š principal stays intact, interest paid periodically; this is a good option temporarily while you decide what to do with the money
____ life income or annuity Š beneficiary receives stipulated benefit on set dates for the lifetime of the claimant
____ fixed installments Š benefits are paid in agreed amounts over a period of time until the money is used up

8. Contact your nearest Social Security office to apply for spouse and dependent benefits. Bring the following information:

____ certified copy of death certificate
____ deceased's Social Security number
____ proof of age of deceased
____ marriage certificate
____ approximate earnings of deceased in year of death
____ deceasedÕs employer's name
____ record of deceased's earnings in year prior to death (use W-2 forms or self employment tax return)
____ Social Security number of spouse and dependent children, proof of age of spouse and dependents (birth certificate, baptism, certificate or grade school records if no birth certificate)

Note: Railroad Worker Benefits are available to the beneficiary rather than Social Security benefits, if the person was employed more than 10 years.

For veterans benefits, you should contact the VA office and take along service discharge papers, serial number, branch and dates of service. Also, the death certificate, marriage certificate, and birth certificates of dependent children.

9. Contact employer and/or business associates to find out about:

____ group life insurance
____ pension fund contributions
____ accrued vacation and sick pay
____ terminal pay allowance
____ gratuity payments (tips)
____ service recognition awards
____ unpaid commissions
____ disability income
____ credit union balance
____ check to see if you and other dependents are still eligible for hospitalization and health insurance

10. Contact organizations to which deceased belonged.

11. After property title changes are complete, contact the insurance company that insures your property to inform them of changes in ownership.

12. Notify state and federal tax authorities.

13. Notify anyone connected with family finances such as attorney, insurance agent, banker, stockbroker, accountant or financial planner.

14. Gather and list all current bills deceased owes and money owed deceased.

Losing a loved one is one of the most stressful experiences of life! You can ease this difficult time in advance by preparing a will and a list of the locations for all financial and professional resource information.


Prepared by Esther M. Maddux, Extension Financial Management Specialist
Reviewed and edited by Wanda W. O'Callaghan, Fran Carmichael
March 1999


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Appendix VI
Household Records: What to Keep and Where


Are your household records in order? If not, now is a good time to get organized. Record keeping isn't a well-liked task but can save you frustration, wasted time and financial loss.

Why Keep Records?

Organized records can mean the difference in financial gain or loss. Your personal finances are like a mini-business and deserve to be operated efficiently. You need organized records for the following reasons.

  1. So your spouse, your children or your executor will have easy access to information needed to settle your estate if something happens to you. Then your heirs can claim benefits rightly theirs and avoid long waits.
  2. So you can readily prove fire or theft losses and thus save time and money in processing your insurance claims
  3. To provide proof of transactions
  4. So you or other family members can find documents on short notice in case of an accident, illness or other emergency
  5. To prove value, payment and cost of ownership
  6. To provide a summary of your financial situation to aid in financial planning, preparation of estate plans, net worth statements, investment and retirement plans
  7. For protection in case official records are destroyed
  8. In a divorce, to prove which is separate and joint property
  9. To prove ownership in a lawsuit or a fight over the inheritance of property
  10. For income tax preparation. They can help save money on taxes, and may be needed during a tax audit.

This record-keeping guide can help you develop a personalized and efficient system for organizing and safeguarding important family papers. Also, use it as a guide for deciding what items to keep, the reason for keeping them, how long you need to keep them, and where they should be kept.

How to Organize Your Home Filing System

An organized filing system is essential to good record keeping. Just tossing receipts in a drawer or shoebox isnÕt always enough. An organized home bill-paying center will help you manage your family financial matters better. Keep all of your family records and business correspondence in one location. Have a specific place to keep bills until they are paid.

The bill-paying center may be elaborate or simple. The type doesn't matter as long as you can find what you need when you need it. Here are some items to keep in your bill-paying center that will make bill paying easier:

  • Home budget book
  • Calendar
  • Paper clips
  • Stapler
  • Postage
  • Calculator
  • Envelopes
  • Stationery
  • Carbon paper
  • Pens
  • Pencils
  • Checks
  • Guide to Home Filing System

    Where do you begin organizing your home filing system? Some categories and headings for filing systems are listed below. It is not intended to be a complete list. You may not want a separate file folder for all items listed. This list is intended as a guideline that you can adapt to your needs. You may wish to consolidate some of the suggested items, use different headings or groupings, and include other items. For example, you may want a divider for insurance or you may want to file insurance papers under separate headings of "auto," "home" or "health."

    Addresses - Dates

    • Birthdays
    • Business
    • Christmas card list
    • Magazine subscriptions
    • Personal

     

    Autos and Vehicles

    • Boats
    • Maintenance-Repair
    • RVs
    • Titles

    Bank Records

    • Checking accounts
      • Canceled checks
      • Deposit receipts
      • Bank statements
    • Credit cards and installment payments
      • Record of card owned
      • Number of each card issued
      • Company name, address, phone number and account number
      • Keep a file for each card
      • Charge accounts
      • Installment agreements
      • Loan contracts
    • Safe deposit box (location and list of contents)
    • Savings accounts
      • Location of books
      • Deposit receipts
      • Interest payment records

    Correspondence

    • Business
    • Personal

    Employment Records

    • Employment contracts
    • Fringe benefits
    • Retirement or pension plans
    • Social Security records
    Equipment and Appliances
    • Guarantee and warranties
    • Instruction manuals
      • Range, refrigerator
      • Air conditioner
      • Heating
      • Laundry
      • Small appliances
      • Personal care appliances
      • Outdoor - lawn mower, etc.
      • Recreational equipment
      • Camera
      • Entertainment - TV, VCR, Stereo
      • Other

    Financial Records

    • Budget
    • Business expenses
    • Educational expenses
    • Gifts and contributions
    • List of financial advisers
    • Loan contracts
    • Master list of important information
    • Net worth statement
    • Property tax records
    • Record of earnings
    • Record of expenditures
    • Sales receipts and paid bills

    Housing

    • Capital improvements
    • Floor plan
    • Household Inventory (second copy in safe deposit box)
    • Lease and rent payments
    • Mortgage payments
    • Utilities
    • Wiring diagrams

    Income Tax

    • Current year information
    • Previous returns

    Insurance Policies

    • Automobiles
    • Disability
    • Health and accident
    • Homeowners
    • Life
    • Other

     

    Investments

    • Annuities
    • Other investments
    • Real estate investments (location, income, expenses)
    • Stocks and bonds (location, number of shares, dates purchased)

     

    Organizations - Clubs

    • Business
    • Church
    • Civic
    • School

    Personal Records

    • Birth certificate
    • Death records
    • Divorce papers
    • Educational records
    • Health records
    • Marriage license
    • Medical and dental records
    • Military records
    • Pet papers
    • Wills, copy of

    Reference Material

    • Cleaning
    • Crafts or hobbies
    • Gardening
    • Home furnishings (care and purchase information)
    • Laundry - hang tags, stain removal
    • Magazine subscriptions and articles
    • Maps
    • Nutrition
    • Others of interest to you
    • Vacations

    What Records Should I Keep for Tax Purposes?

    You must keep records so that you can prepare a complete and accurate income tax return. The law does not require any special form of records. However, you should keep all receipts, canceled checks or other proof of payment, and documentation to support any deductions or credits you claim.

    If you file a claim for refund, you must be able to prove by your records that you have overpaid your tax (IRS 1999, p.19).

    How Long to Keep Records

    You must keep your records for as long as they are important for the federal tax law. Keep records that support an item of income or a deduction appearing on a return until the period of limitations for the return runs out. A period of limitations is the limited period of time after which no legal action can be brought. For assessment or collection of tax you owe, this is three years from the date you filed the return. For filing a claim for credit or refund, this is three years from the date you filed the original return or two years from the date you paid the tax, whichever is later. Returns filed before the due date are treated as filed on the due date.

    If you did not report income that you should have reported on your return, and it is more than 25 percent of the income shown on the return, the period of limitations does not run out until six years after you filed the return. If a return is false or fraudulent with intent to evade tax, or if no return is filed, an action can generally be brought at any time.

    In real property transactions, the basis of new or replacement property may depend on the basis of the old property. Keep the records of transactions relating to the basis of property for as long as they are important in figuring the basis of the original or replacement property.

    You should keep copies of tax returns you have filed and the tax return documentation as part of your records. They may be helpful in amending filed returns or preparing futures ones.

    Where Should You Keep Your Records?

    You can save yourself future time and money if you gather your important records, track down the ones you're missing, throw away those you don't need and file what's left in its proper place. You don't have to do the whole job in a day or even a week. Tackle it a chunk at a time.

    Before you set up your record-keeping system, decide who will do the record keeping and where it will be done. Encourage all family members to save financial information, such as receipts, and know how to use the files. A person with the skills and interest to handle the job will want to take leadership. Develop a regular schedule for bookkeeping and stick to it.

    Your records can be divided into several categories:

    1. Records that need to be kept in a safe deposit box or fireproof strong box
    2. Current financial records that you keep at home
    3. Permanent records that you keep at home
    4. Records to carry with you

    A Safe Deposit Box

    Certain records are difficult or impossible to replace. Keep them in a safe deposit box at a financial institution or at home in a fireproof box. You need to keep things like your car title, birth certificate, marriage certificate and will in your safe deposit box.

    Current Financial Records

    File current records in a metal file cabinet, accordion file or cardboard box. Choose a location to store your financial records that is convenient and easily located; a work place nearby is ideal.

    Permanent Records

    At the end of your record-keeping year, clear your current files. Throw away items that are no longer of any value, such as sales receipts for groceries. Move important papers to your permanent file. A good time to clean your files is when you prepare your income tax return. As you look for tax items, throw away items you no longer need and transfer items you may need in the future to your permanent files. Keep items such as tax returns and bank statements.

    Records to Carry With You

    Certain records need to be with you at all times. You need to carry records such as credit cards, driverÕs license and insurance card with you in your wallet. Your insurance card and emergency information in case of an accident can be placed in a storage compartment in your car.

    What Goes Where?

    One of the big record-keeping problems is knowing what to keep, where to keep it and what to throw away. Here are some guidelines to help you decide.

    Where You Should Keep Records and Papers*

    Item

    In a Safe Place

    Filed at Home

    With You

    Safe Deposit Box

    Current File

    Permanent File

    Purse or Billfold

    Account books

     

    X

    X

     

    Adoption papers

    X

         

    Auto license receipt

         

    X (in car)

    Auto title and bill of sale

    X

         

    Bank statements

     

    X

    X

     

    Baptism and confirmation certificates

    X

         

    Birth certificates

    X

         

    Canceled checks (for year)

     

    X

       

    Canceled checks Š for payment of taxes and other important purposes

       

    X

     

    Citizenship papers

    X

         

    Contracts Š installment (and for six years after paid)

    X

         

    Copyrights and patents

    X

         

    Credit cards

     

    X (list)

       

    Death certificate

    X

         

    Driver's license and insurance card

         

    X

    Employment record

       

    X

     

    Government savings bonds

    X

         

    Guarantees, warranties, instruction books

     

    X

    X

     

    Health records

       

    X

     

    Identification Š name, address, whom to notify, special health information, doctor and hospital preferred

         

    X

    Installment notes

    X

         

    Letter regarding government insurance awarding compensation for service incurred disability

    X

         

    List of insurance policies

    X

     

    X
    (actual policy)

     

    Living will, durable power of attorney for health care, statutory financial power of attorney

       

    X

     

    Marriage, divorce and custody papers

    X

         

    Military discharge papers and records

    X

         

    Organization membership

         

    X

    Real estate papers

    Abstracts

    X

     

     

     

    Deeds and mortgages

    X

     

     

     

    Periodic receipts

     
    X
    X
     

    Receipts and receipted bills
    (important ones should be for six years)

     

    X

    X

     

    Social Security card

    Top portion

         
    X

    Bottom portion

    X
         

    Stock Certificates, other investments

    X

         

    Tax returns

    Income tax

       
    X
     

    Property tax

       
    X
     

    Wills, gift records, trusts

    X

         

    * An explanation of each record follows this table.


    Records to Keep in Safe Deposit Box or Fireproof Strong Box

    Item

    Suggested Uses

    Adoption papers

    Need for Social Security, inheritance, veterans federal pension compensation and other benefits.

    Automobile title (truck, motorcycles, etc.)

    Evidence of ownership, essential for transfer to new owner when car is sold.

    Automobile bill of sale

    Contains motor number, serial number and other important information. You will have necessary information if auto is stolen or if you use it as collateral for a loan.

    Birth certificate

    A copy may be kept at home. To prove ages to start school, to register for little league, for obtaining some jobs, to obtain driver's license, for marriage license, to qualify for Social Security benefits, to obtain passports.

    Church records

    Baptismal and confirmation certificates. Acceptable evidence of birth date when obtaining a delayed birth certificate.

    Citizenship papers

    To obtain certain types of jobs, to obtain passports, prove eligibility to vote.

    Contracts, notes and debts

    Evidence of what you owe or what is owed to you. Important for interest deductions on tax return and to indicate fulfillment of contract terms. If someone owes you money, you may not be able to get debtor to sign another note if lost or destroyed. Make a memo of money lent without a formal note. Survivors may not be able to collect, but they can try. When debt is repaid, cancel note immediately so heirs won't try to collect.

    Copyrights and patents

    Proof of ownership rights.

    Custody papers

    To prove legal guardianship of children.

    Death certificate

    Need for identification to receive Social Security, veteran, pension and insurance benefits.

    Divorce records

    To clear legal requirements for remarriage.

    Gift records

    Keep records of substantial gifts to others. This includes cash, property, art, cars and jewels.

    Government savings bonds

    Keep written record at home of issuing date, complete serial number, denomination, co-owner (if any), and (after redemption) amount received. Need for income tax, for gift tax report if you give it away, for ease of replacement in case of loss.

    Household inventory

    Write down the date purchased and personal possessions you buy or receive as gifts during the year. Transfer this information once a year to your complete household inventory in a safe deposit box. Include snapshots or video of rooms and sales receipts proving cost of major items. Need in case of fire or theft to prove to insurance company exactly what you had. Makes it easier to recover losses. Need for determining net worth, when determining insurance needs, applying for loans, settling divorce, applying for adoption or planning financial future.

    Investments

    Keep a list of savings accounts, stocks, bonds, real estate and other investments along with location and numbers at home. Keep investments, including stock and bond certificates, in your safe deposit box. Keep complete records of when they were bought and sold, at what price and commission paid. Need for estate and income tax purposes.

    List of insurance companies, policy numbers, name of each insured, and agents

    Policy can be easily replaced by company, but all information concerning policy is vitally important. Keep policies in home file.

    Marriage records

    For proof of marriage, to obtain driver's license (if female changes last name to spouse's name), to collect insurance, to collect Social Security, to settle estate.

    Military service records

    Records you need to keep to qualify for veterans benefits include: medical treatment or disability papers. Some authorities recommend that the county or city clerk record discharge certificates to create additional official record in case the original is lost. Include all documents connected with the GI Bill for education.

    Passports

    If your passport has expired, keep it anyway. It will help you get a new one.

    Real estate papers

    Abstract

    Keep until property is sold to prove clear title.

    Deeds and mortgages

    Keep title, property insurance policy and receipts for payments on mortgage. Keep records of improvement to compute capital gains or losses. Record day, month and year you acquire or sell property, gross sale price, depreciation, legal fees and expense of sale. Need for income tax and estate tax purposes.

    Retirement records

    Needed to collect benefits. Keep notes on pension or profit sharing money you have. Keep IRA and Keogh documents and information on where assets are invested.

    Social Security card

    Keep copy of card or number from card.

    Wills and trust documents

    Keep original in safe deposit box. Keep a copy in strong box at home. Essential for most satisfactory settlement of estate. Leave copy with attorney who drew it up or with bank trust department.


    Records to Keep at Home

    Item

    Suggested Uses

    Account books

    Record income and expenditures for reference and comparison. Useful to determine net worth.

    Bank records

    Keep all bank statements, canceled checks, passbooks and correspondence in your current files for current year. Keep all old check stubs and bank statements, passbooks and canceled checks in your permanent files. Canceled checks can prove you paid for home improvements so you can reduce capital gains tax.

    Business expenses

    If you are eligible to claim business expenses, you need a diary to substantiate deductions. Enter expenses daily in a diary and attach receipts.

    Casualty and theft losses

    Keep records of casualty and theft losses due to vandalism, fire, storm, flood, accidents or similar causes.

    Credit cards, mortgage loans, installment purchases, charge accounts

    Keep statements in current file to tell how much you owe, if payments are properly credited and amount of interest paid. Keep a list of company name, address, phone number and account number for each credit card. In case of loss or theft, notify nearest company office by telephone or telegraph. Give your name, address, card number, where and when you think it was lost or stolen, and whether you reported loss to police. Follow up with a letter giving same information.

    Death records

    Location of burial plot, where deed is kept, arrangements for care of lot. Any final instructions with regard to your funeral, donating organs for transplant or other personal requests. Date and place of death of family members, where buried.

    Education and employment

    Keep on file all permits, licenses, proficiency certificates, résumés, information on union membership and names of past employers. Need when seeking employment. Evidence of qualification for certain work. Evidence of reliability and tenure. Used to determine retirement benefits.

    Employee benefits

    In current file, keep company booklets explaining your benefits.

    Employee education expenses

    If your education meets qualifying education requirements, you can deduct your educational expenses if you itemize your deductions or if you are self-employed. The education must:

    1) Be required by your employer or the law to keep your present salary, status, or job (and serve a business purpose of your employer), or 2) maintain or improve skills needed in your present work.

    Financial advisers

    List of names, addresses and telephone numbers including your banker, broker, lawyer, accountant, insurance and real estate agents and the employee-benefits counselor at work.

    Gifts

    Keep receipts for tax deductible, charitable contributions in your current file. You may deduct unreimbursed out-of-pocket expenses incurred as result of charitable activity.

    Guarantees and warranties

    File for proof of date of purchases; to determine service and parts guaranteed. Keep until no longer valid.

    Health records

    For each family member: record of immunizations, blood type, dates of major illness, surgery, hospitalizations, checkups and physicians having record of each.

    Instruction manuals

    Keep instructions on how to operate appliances and other products, and where they can be repaired. Discard when out of date. Read and file use and care instructions for clothing, fabrics and furniture.

    Insurance policies

    Health, accident and disability

    Keep policy, along with any change of beneficiary, correspondence with company and proof of ownership if you transfer policy to some else.

    Life

    Keep policy, along with any change of beneficiary, correspondence with company and proof of ownership if you transfer policy to someone else.

    Mortgage, credit information

    Keep list of debt information such as to whom money is owed, how much is owed.

    Property: automobile, boat, homeowners

    Keep current policies in your file box or fireproof strong box. Keep old policies in permanent files. If a claim for an old injury that occurred on your property is filed against you, you may need proof of earlier coverage.

    Keys

    To reduce the frustration of lost keys, put extra keys in labeled, sealed envelopes inside file folder.

    Master list of important information

    Enter all of your important documents, the identifying number and where they can be found. Include all family, property, financial and tax records. Also include where safe deposit box key is located.

    Medical and dental expenses

    Keep receipts for medical expenses in current files to prove any deductions you may be eligible to claim.

    Rental property

    Keep complete records of all expenses and current income from rental property in current files. Keep records of previous years in permanent files.

    Safe deposit box rent

    Tax deductible if you use the box to store taxable-income producing stocks, bonds or investment-related papers and documents.

    Tax records

    Keep tax returns, proof of income received and receipts or canceled checks necessary to substantiate tax deductions for at least three years from due date of return. Normally IRS doesn't audit your taxes once three years have passed. IRS has six years to assess extra tax if your actual income is 25 percent more than reported income. You can be audited any time in case of fraud or where no return was filed. No statute of limitations exists.


    Records to Carry With You

    Item

    Suggested Uses

    Automobile license receipt

    Must have to purchase new license plate.

    Automobile insurance card

    To prove you have automobile insurance.

    Credit card

    Identification; to charge purchases.

    Driver's license

    Identification and evidence of legal ability to drive.

    Identification

    Blood type

    Emergency treatment. Place note in household files for ready reference in case of loss.

    Medicare or insurance card

    For identification to receive benefits when admitted to hospital.

    Name, address, whom to notify doctor and hospital preferred

    Personal information and persons to contact in case of emergency. Name, address and telephone numbers in case emergency treatment is needed.

    Special health information

    Diabetic

    Emergency treatment

    Epileptic

    Emergency treatment

    Allergies

    Emergency treatment

    Organization membership

    Identification and proof of membership.

    Social Security card

    Identification. Number should be listed at home. Keep a copy of card in safe deposit box.

    * Keep anything you can't replace or would be costly or troublesome to replace in your safe deposit box. Keep list of safe deposit box contents at home.

    Summary

    Take time to organize your household records now. You can save frustration, wasted time and financial loss in the future. Develop a system that works for you so you can safeguard your important papers. Organize a record-keeping system so you know what to keep, where to keep it and how long.

    Resources Available

    The Internal Revenue Service has free publications that you can order or view online.

    To order by phone, call 1-800-TAX-FORM (1-800-829-3676); online, visit www.irs.ustreas.gov.

    Reference

    Acknowledgments

    The author expresses special thanks to the following people who reviewed the manuscript and shared their suggestions: Ms. Betty Beaver, Internal Revenue Service; Dr. Nayda Torres, The University of Florida Cooperative Extension Service; and Mrs. Rose Simmons, Georgia Cooperative Extension Service.

    Prepared by Esther M. Maddux, Ph.D., C.F.P., Extension Financial Management Specialist


    Back to main document

    Appendix VII
    Financial Record Book


    Instructions

    The "Financial Record Book" provides a ready reference to your current financial situation. It should be placed in a convenient location. Let someone you trust Ń a family member, your attorney, banker or executor Ń know where it is in case of an emergency or death. Update it periodically to reflect any important changes.

    If you need more spaces, duplicate the pages. You may want to start a financial notebook. A loose-leaf notebook would allow you to add pages as needed in certain sections. Use pencils so that forms can be easily updated. You may want to give a copy of a completed book to someone you trust so he or she will have it in case of an emergency.

    Personal and Family Information

    Name: Last

    First Middle Maiden

    Social Security #

     

    Age: Date of Birth

    Birthplace (city, county, state)

     

    Citizen of

    Residence: Street

    City, County, State, ZIP Years Phone

    Previous Address

    Employer

    Occupation Years

    Employer Address: Street

    City, County, State, ZIP

     

    Phone

    Marital Status: Single, Married (Date married), Widowed, Divorced, Separated

    Previous Marriages

    High School

    City, County, State Degree/Date

    College

    City, County, State Degree/Date

    Graduate School

    City, County, State Degree/Date

    Other

    City, County, State Degree/Date

    Branch of Military Service

    Serial #

    Enlistment Date

    Discharge Date Highest Rank

    Church Membership

    Affiliation

    Fraternal, Service, Social and Union Memberships

    Special Recognition:

    Father's Full Name

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

    Mother's Full Name (Include Maiden)

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

    Brothers and Sisters:

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

     

    Children: Name

    Age Date of Birth Social Security # This marriage

    Adopted

     

     

    Marital Status

     


    Spouse's Name: Last

    First Middle Maiden

    Social Security #

     

    Age: Date of Birth

    Birthplace (city, county, state)

     

    Citizen of

    Residence: Street

    City, County, State, ZIP Years Phone

    Previous Address

    Employer

    Occupation Years

    Employer Address: Street

    City, County, State, ZIP

     

    Phone

    Marital Status: Single, Married (Date married), Widowed, Divorced, Separated

    Previous Marriages

    High School

    City, County, State Degree/Date

    College

    City, County, State Degree/Date

    Graduate School

    City, County, State Degree/Date

    Other

    City, County, State Degree/Date

    Branch of Military Service

    Serial #

    Enlistment Date

    Discharge Date Highest Rank

    Church Membership

    Affiliation

    Fraternal, Service, Social and Union Memberships

    Special Recognition:

    Father's Full Name

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

    Mother's Full Name (Include Maiden)

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

    Brothers and Sisters:

    Living (Y/N) Age Dependent (Y/N) Health

    Cause of Death if Deceased

     

    Date of Birth

     

    Children: Name

    Age Date of Birth Social Security # This marriage

    Adopted

     

     

    Marital Status

     


    Professional and Personal Advisers
    *

    ATTORNEY:

    ACCOUNTANT:

    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.
    ______________________________

    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.
    ______________________________
    BANKER: REAL ESTATE BROKER:
    Name_____________________________________
    Name of institution__________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    INSURANCE REPRESENTATIVE: TRUST OFFICER:
    Name_____________________________________
    Name of agency____________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    BROKER: FINANCIAL PLANNER:
    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Name of firm_______________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    BUSINESS PARTNER: CLERGYMAN:
    Name_____________________________________
    Name of business___________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Name of church_____________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    DOCTOR: NEAREST RELATIVE:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    ____________________________: ____________________________:
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________
    Name_____________________________________
    Address___________________________________
    __________________________________________
    Telephone No.______________________________

    *Many of these may not apply to your situation. The number of advisers you have will vary according to your financial situation and your stage in the family life cycle.


    Where Are the Following Important Records?

    List the location of these documents.

    Original Will

    Copy of Will

    Original Trust

    Copy of Trust

    Power of Attorney

    Real Estate Deeds

    Insurance Policies (Life, Health, Disability, Property)

    Loans, Investments, Retirement Accounts

    Security Certificates

    Pension Certificates

    Business Agreements

    Notes Receivable & Payable

    Bank Books (Checking, Savings)
    (Credit, Charge Account Numbers)

    Installment Payment Books

    Automobile Registration & Title

    Inventory of Household Goods

    Inventory of Farm or Business

    Personal Property Tax Receipts

    Income & Gift Tax Returns

    Social Security Card & Number
    (For each family member)

    Employment Records
    (W-2 forms & other records of earnings)

    Naturalization Papers

    Military Service Papers

    VA Education/Housing Entitlement Papers

    Marriage Certificate

    Pre- or Postnuptial Agreements

    Divorce Records

    Birth Certificates of All Family Members

    Baptismal Certificates
    Death Certificates

    Adoption Papers

    Safe Deposit Box

    • Name Registered In
    • Where is Key?
    • Persons Authorized to Sign

    Sources of Income

     
    Amount*
     

    Per Week

    Biweekly

    Per Month

    Per Year

     

    gross

    net

    gross

    net

    gross

    net

    gross

    net

    Paycheck #1

                   

    Paycheck #2

                   

    Paycheck #3

                   

    Paycheck #4

                   

    Tips

                   

    Commission

                   

    Interest

                   

    Dividends

                   

    Rent

                   

    Gifts

                   

    Annuities

                   

    Social Security

                   

    Retirement Benefits

                   

    Child Support

                   

    Alimony

                   

    Supplemental Security Income

                   

    Public Assistance

                   

    Veterans Benefits

                   

    Profits-Business, farm

                   

    Loan Proceeds

                   

    Other

                   

    Totals

                   

    * Choose one of these columns to reflect the amount of your income. You only have to fill in one of the income sources.


    Determine Income

     

    Dollar Amount

    Deductions

    Paycheck #1

    Paycheck #2

    Paycheck #3

    Paycheck #4

    Federal Taxes

           

    State Taxes

           

    Social Security (FICA)

           

    Retirement Plan #1

           

    Retirement Plan #2

           

    Retirement Plan #3

           

    Insurance:

    Hospitalization

           

    Accident

           

    Disability

           

    Life

           

    Other

           

    Miscellaneous:

    Savings

           

    Credit Union

           

    Charity

           

    Union Dues

           

    Uniforms

           

    Other

           

    Total Deductions

           

    Gross Pay

           

    Total Deductions

           

    Net Pay

           

    To find out what portion of gross pay is used for deductions, divide your deductions by gross pay and multiply by 100.

    Total deductions
    Gross Income
    $ 529.85
    $1,541.67
    = .344 X 100 = 34.4%
    Spendable Income
    Gross Income
    $1,011.82
    $1,541.67
    = .656 X 100 = 65.6%

    If your total deductions are $529.85 and your gross pay is $1,541.67, then 34.4% of your income goes for deductions and 65.6% or $1,011.82 is available to spend or save.


    Paycheck Planning Sheet

    This worksheet allows you to compare income and expenses as well as plan for the next pay period. Place the amount of income you have available for family living expenses at the top of the first "spent" column beside amount of check. Place the amount of your expenses beside each expense, under the "spent" column. Then you use the "plan" column to make adjustments for the next pay period.

    Date of check

                   

    Take-home pay

                   

    Item

    Spent

    Plan

    Spent

    Plan

    Spent

    Plan

    Spent

    Plan

    Housing

                   

    Utilities

                   

    Food

                   

    Transportation

                   

    Clothing and personal care

                   

    Medical and health

                   

    Education

                   

    Recreation/entertainment

                   

    Church/contributions

                   

    Credit

                   

    Savings

                   

    Other

                   

    Total expenses

                   

    Total monthly income

                   

    Total monthly expenses

                   

    Net

                   
           

    Housing
    rent or mortgage
    property taxes
    property insurance
    repairs
    home furnishings/equipment
    household maintenance/repair
    household help
    homeowner's association fee
    other

    Utilities
    water
    electricity
    gas
    telephone
    cable TV
    pest control
    garbage
    other

    Food
    food at home
    food away from home
    food for entertaining
    snacks
    beverages

    Transportation
    car payment
    gas and oil
    maintenance
    repairs
    license plate
    auto insurance
    bus, taxi
    other

    Clothing and Personal Care
    clothes
    dry cleaning
    laundry
    cosmetics
    toiletries
    shoes
    shoe repair
    hair care
    personal care

    Medical and Health
    life insurance
    health insurance
    disability insurance
    medicine and drugs
    medical and dental visits
    hospital
    eyeglasses, braces
    special medical needs

    Education
    school supplies
    tuition/fees
    other

    Recreation/Entertainment
    books, newspapers, magazines
    membership dues
    movies
    sports
    hobby supplies
    vacation, travel
    pet expenses
    stationery, postage
    spa/health club

    Church/contributions

    Credit
    installment debts
    personal loans
    life insurance loans
    credit cards

    Savings

    Other
    gifts
    family and friends
    tobacco
    alcohol
    child care
    household help
    business expenses
    taxes
    lottery
    other


    Cash Flow Worksheet

     

    Due

    Week 1

    Week 2

    Week 3

    Week 4

    Week 5

    Income

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Expenses

     

    Budge/Spent/Balance

    Budget/Spent/Balance

    Budget/Spent/Balance

    Budget/Spent/Balance

    Budget/Spent/Balance

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Totals

     

     

     

     

     

     


    Seasonal Expenses

    January

    February

    March

     

     

     

     

       

    April

    May

    June

     

     

     

     

       

    July

    August

    September

     

     

     

     

       

    October

    November

    December

     

     

     

     

       

    January

    February

    March

     

     

     

     

       

    April

    May

    June

     

     

     

     

       

    July

    August

    September

     

     

     

     

       

    October

    November

    December

     

     

     

     

       


    Debts/Liabilities

    Loans (Mortgages, car loan, installment debts, personal loans, life insurance loans, charge accounts, credit cards, taxes, notes payable, accounts payable, interest payable)

    Type of Loan/Debt

    Name of Lender

    Name of Borrower*

    Loan Amount

    Date Made MO/YR

    Secured By

    Interest Rate

    Length of Loan

    Monthly Payment

    Payment Due Date

    Total Balance Due

    Date Paid Last

                         

     

                         

                         

     

                         

     

                         

     

                         

     

                         

     

                         

     

                         

     

                         

     

                         

                         

     

                         
                           

    TOTAL

    $_______

     

    $_______

     

    $_______

     

    * Name of Borrowers Š You, Your Spouse, You and Co-signer, Other (Specify)


    Life Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Name of Company

         

    Name(s) of Insured

         

    Purchase Date

         

    Type of Policy1

         

    Policy Number

         

    Face Value

         

    Owner of Policy

         

    Beneficiary(ies)2

         

    Premium $/Date Due3

         

    Current Cash Value

         

    Outstanding Loans

         

    Location of Policy

         

    Agency/Address

         

    Contact Person

         

    Telephone Number

         

    Other4

         
    Notes: 1 Type of Policy Š Term, whole, universal, variable; group or individual
    2
    Beneficiary Š Husband, wife, children, other
    3
    Due Date Š Annual, semiannual, quarterly, monthly, automatic deduction
    4
    Other Š Dividend status, riders, waiver of premium, grace period, accidental death provisions


    Disability Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Name of Company

         

    Person(s) Covered

         

    Purchase Date

         

    Policy Number

         

    Percent of Salary Replaced

         

    Premium $/Date Due

         

    Waiting Period
    (Sickness, accident, partial disability)

         

    Length of Coverage
    (Time Period of Benefits)

         

    Monthly Benefit

         

    Coordination With Other Income

         

    Definition of Disability

         

    Residual Clause

         

    Retirement Plan/
    Eligibility Requirements

         

    Location of Policy

         

    Agency/Address

         

    Contact Person

         

    Telephone Number

         


    Dental Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Name of Company

         

    Person(s) Covered

         

    Purchase Date

         

    Policy Number

         
    Coverages

    Preventive Dental Services

         

    Routine and Major Restorative Services

         

    Orthodontics Lifetime Maximum

         

    Annual Maximum Plan Benefit

         

    Deductible

         

    Premium $/Date Due

         

    Location of Handbook

         

    Agency/Address

         

    Telephone Number

         


    Health Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Purchase Date

       

     

    Company Name

       

     

    Company Address

     

     

     

    Company Phone

       

     

    Agent Name

       

     

    Policy Number

       

     

    Type:

    Basic (Hospital, surgical, physician)

       

     

    Major Medical

       

     

    Comprehensive

       

     

    Health Maintenance

       

     

    Medicare

       

     

    Other

       

     

    Group

       

     

    Individual

       

     

    Persons Insured:

       

     

       

     

       

     

       

     

    Premium (When Paid) ($)

       

     

    Deductible ($)

       

     

    Coinsurance ($)

       

     

    Annual Stop Loss Limit ($)    

     

    Lifetime Maximum    

     

    Inpatient Hospital Services    

     

    Room and Board

       

     

    Dollar Amount

       

     

    Maximum Number of Days

       

     

    Private or Semiprivate

       

     

    Intensive/Cardiac Care Unit

       

     

    Inpatient Surgery    

     

    Physician's Expense    

     

    Emergency Accident Treatment    

     

    Skilled Nursing Home Care    

     

    Outpatient Surgery    

     

    Outpatient Diagnostic/Radiation Therapy    

     

    Maternity Care    

     

    Ambulance    

     

    Home Health Care/Hospice Care    

     

    Psychiatric/Substance Abuse Care    

     

    Prescriptions    

     

    Preventive Care    

     

    Pre-exisitng Conditions    

     

    Location of Handbook

       

     


    Homeowner's/Renter's Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Name of Company

         

    Policy Number

         

    Location of Property

         

    Type of Coverage (all risks or named perils)

    House

         

    Other Structures

         

    Personal Property

         

    Loss of Use

         

    Personal Liability

         

    Damage to Property of Others

         

    Medical Payments to Others

         

    Replacement Value of Property (actual cash value or replacement value)

         

    Date Purchased Home

         

    Purchase Price of Home

         

    Location of Deed

         

    Current Market Value

         

    Mortgage Holder

         

    Monthly Mortgage Payment/Due Date

         
    Deductible      
    Inflation Coverage Index      
    Personal Items Coverage (floater)      

    Policy Number

         

    Coverage Amount

         

    Premium/Due Date

         

    Inflation Coverage Index

         
    Location of Policy      
    Premium $/Due Date      
    Expiration Date      
    Agency/Address      
    Contact Person      
    Telephone Number      


    Automobile Insurance

     

    Policy 1

    Policy 2

    Policy 3

    Name of Company

         

    Year/Make/Model of Auto

         

    Registration Number/Title Number

         

    License Plate Number

         

    Policy Number

         
    Liability Coverage Š Bodily Injury

    Each Person

         

    Each Accident

         

    Property Damage

         

    Medical Payments Coverage

         
    Uninsured/Underinsured Motorist Coverage

    Each Person

         

    Each Accident

         

    Property

         

    Deductible

         

    Collision Deductible

         
    Comprehensive Deductible      
    Emergency Road Service      
    Car Rental      
    Umbrella Liability      
    Premium $/Date Due      
    Expiration Date      
    Location of Policy      
    Agency/Address      
    Contact Person      
    Telephone Number      
    Location of Title      
    Holder of Lien(s)      

    Pay-off Date

         

     

    Cash and Cash Equivalents

    How much are you saving each month?_______________________________________________________

    How? (Payroll Deductions, etc.)_____________________________________________________________

    Cash on Hand___________________________________________________________________________

    Checking Accounts

    Account Holder(s)

    Type of Account

    Account Number

    Interest Rate

    Branch Name/Address

    Ownership*

    Present Balance

             

     

     
                 
                 

    Savings/Money Market Account

    Date Opened

    Initial Rate

    Current Rate

    Name/Address of Institution

    Account Number

    Ownership

    Present Amount

                 
                 
                 

    Certificates of Deposit

    Date Purchased

    Date of Maturity

    Interest Rate

    Name/Address of Institution

    Account Number

    Ownership

    Principal Amount

                 
                 
                 
                 
                 
                 

    Savings Bonds

    Date Purchased

    Type

    Amount Purchased

       

    Ownership

    Present Amount

                 
                 
                 
    Total in personal accounts  

     


    How much are you saving each month?
    _______________________________________________________

    How? (Payroll Deductions, etc.)_____________________________________________________________

    Cash on Hand___________________________________________________________________________

    Checking Accounts

    Account Holder(s)

    Type of Account

    Account Number

    Interest Rate

    Branch Name/Address

    Ownership*

    Present Balance

             

     

     
                 
                 

    Savings/Money Market Account

    Date Opened

    Initial Rate

    Current Rate

    Name/Address of Institution

    Account Number

    Ownership

    Present Amount

                 
                 
                 

    Certificates of Deposit

    Date Purchased

    Date of Maturity

    Interest Rate

    Name/Address of Institution

    Account Number

    Ownership

    Principal Amount

                 
                 
                 
                 
                 
                 

    Savings Bonds

    Date Purchased

    Type

    Amount Purchased

       

    Ownership

    Present Amount

                 
                 
                 
    Total in personal accounts  

    * Ownership Š Sole ownership (husband or wife), joint tenants, tenancy in common


    Stocks

    Company

    Ownership1

    Number of Shares

    Type2

    Current Dividend3

    Date Purchased

    Purchase Price Per Share

    Total Cost

    Current Price Per Share

    Current Market Value

                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
    Notes: 1 Ownership Š Sole ownership (husband, or wife), joint tenants, tenancy-in-common
    2 Type Š Preferred/common
    3 Current Dividend Š Are dividends reinvested? Are stocks pledged as collateral?


    Bonds

    Company

    Ownership*

    Number of Units Purchased

    Purchased Price Per Unit

    Total Cost

    Coupon Interest

    Date Purchased

    Maturity Date

    Current Price Per Unit

    Current Market Value

    Corporate

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Government/Municipal

                       
                       
                       
                       
                       
                       
                       

    * Ownership Š Sole ownership (husband, or wife), joint tenants, tenancy-in-common, other (pledged as collateral)

     

    Mutual Funds

    Company

    Ownership

    Number of Units

    Payment Plan*

    Capital Gains Reinvested

    Dividends Reinvested

    Purchase Date

    Unit Cost

    Total Cost

    Current Price/Unit

    Current Market Value

                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         

    * Payment plan Š Monthly, quarterly


    Retirement Plans Š Husband

    Type

    Personal Annual Contribution

    Company Annual Contribution

    Amount Vested/When

    Retirement Disbursements

    Death Benefits

    Monthly Annuity Begin/End

    Lump Sum

    Monthly Annuity Begin/End

    Beneficiary

    Current Market Value

    Individual Retirement Account

     

     

    /

    /

     

    /

     

     

    Keogh Plan (HR-10)

     

     

    /

    /

     

    /

     

     

    Tax Deferred Annuity 401(K), 403(b)

     

     


    /


    /

     


    /

     

     

    Qualified Pension Plan

     

     

    /

    /

     

    /

     

     

    Profit Sharing

     

     

    /

    /

     

    /

     

     

    Stock Bonus

     

     

    /

    /

     

    /

     

     

    Employee Stock Purchases

     

     

    /

    /

     

    /

     

     

    Qualified Thrift Plan

     

     

    /

    /

     

    /

     

     

    Deferred Compensation

     

     

    /

    /

     

    /

     

     

    Social Security

     

     

    /

    /

     

    /

     

     


    Retirement Plans Š Wife

    Type

    Personal Annual Contribution

    Company Annual Contribution

    Amount Vested/When

    Retirement Disbursements

    Death Benefits

    Monthly Annuity Begin/End

    Lump Sum

    Monthly Annuity Begin/End

    Beneficiary

    Current Market Value

    Individual Retirement Account

     

     

    /

    /

     

    /

     

     

    Keogh Plan (HR-10)

     

     

    /

    /

     

    /

     

     

    Tax Deferred Annuity 401(K), 403(b)

     

     


    /


    /

     


    /

     

     

    Qualified Pension Plan

     

     

    /

    /

     

    /

     

     

    Profit Sharing

     

     

    /

    /

     

    /

     

     

    Stock Bonus

     

     

    /

    /

     

    /

     

     

    Employee Stock Purchases

     

     

    /

    /

     

    /

     

     

    Qualified Thrift Plan

     

     

    /

    /

     

    /

     

     

    Deferred Compensation

     

     

    /

    /

     

    /

     

     

    Social Security

     

     

    /

    /

     

    /

     

     


    Real Property

     

    Address

    Location of Deed

    Ownership*

    Date of Purchase

    Purchase Price

    Residence

             

    Vacation Property

             

    Cemetery Plot

             

    Income Producing Property

             
             
             
             

    Unimproved Real Property

             
             
             
             

    Farmland/Farm Buildings

             
             
             
             

    Business

             
             
             
             

    * Ownership Š Sole ownership (husband or wife), joint tenants, tenancy-in-common


    Farm Assets

     

    Ownership

    Number of Units

    Date Acquired

    Purchase Price

    Current Market Value

    Livestock

             
             
             
             
             
             
             

    Feed Crop and Supplies

             
             
             
             
             
             
             

    Machinery/Equipment*

             
             
             
             
             
             
             

    * Machinery/Equipment Š Above ground and below ground


    Receivables: Notes/Accounts/Mortgages

    Who Owes You?

    Address

    Where Is the Note?

    Interest Accrued

    Amount/Maturity Date

             
             
             
             


    Leases

     

    Leases

    Where Is the Lease?

    Name(s)

    Royalties, Mineral Rights

         
         
         
         

    Crop and Pasture Land

         
         
         
         


    Investment Assets

     

    Purchase Price

    Date of Purchase

    Current Market Value

    General Partnership Interests

         
         
         
         
         
         
         
         

    Limited Partnership Interests

         
         
         
         
         
         
         

    Closely Held Corporate Stock

         
         
         
         
         
         
         


    Personal Property

     

    Purchase Price

    Date of Purchase

    Current Market Value

    Automobiles

         
         
         

    Motorcycles/Motor Home, etc.

         
         

    Boat

         

    Airplane

         

    Household Furnishings and Equipment

         

    Jewelry, Furs, Antiques, Art, etc.

         

    Hobby Assets (Coins, Stamps, Guns, etc.)

         
         

    Other

         
         

    Comments:


    Net Worth Statement for Three Years
    */**

    Assets Owned

    19

    19

    19

    Liquid Assets

    Whole Life Insurance Cash Value

         

    Cash on Hand and in Bank

         

    Checking Accounts

         

    Savings Accounts

         

    Money Market Accounts

         

    Certificates of Deposit

         

    Savings Bonds

         

    Investments

    Stocks

         

    Corporate Bonds

         

    Government/Municipal Bonds

         

    Mutual Funds

         

    Retirement Plans

         

    Other

    Real Property

         

    Farm Assets

         

    Business Assets

         

    Personal Property

         

    Total Assets

         

    Liabilities Owed

    $ $ $

    Mortgage

         

    Car Loan

         

    Installment Debts

         

    Personal Loans

         

    Life Insurance Loans

         

    Charge Accounts

         

    Credit Cards

         

    Taxes

         

    Payables

         

    Total Debts

         
     

    Your Total Net Worth

    19

    19

    19

    Total Assets

         

    Total Liabilities

         

    Net Worth = Assets - Liabilities

         

    * To calculate your net worth, list the fair market value of you assets. List the outstanding balance on your debts. Total assets. Total liabilities. Subtract liabilities from assets to get net worth.
    ** Beside each item list how owned: sole owner (husband or wife), joint tenancy with right of survivorship, tenant-in-common


    Analysis of Personal Finances

    After reviewing my personal financial records, I need to make the following changes:

    1. Record keeping

     

    2. Cash flow

     

    3. Credit use

     

    4. Insurance

     

    5. Investments

     

    6. Tax planning

     

    7. Retirement plan/employee benefits

     

    8. Estate plan

     


    References


    Back to main document


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    Bulletin 1018, May 2000

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