Personal Data Record

Kajko, Weisman & Colasanti, LLP

430 Bedford Street, Suite 190
Lexington, MA 02420
rkeshian@massfirm.com

Personal Data Record

(Date this record was last revised __________)

Location of Important Documents

1. Adoption Papers ______________________________________________________

2. Automobile Titles ______________________________________________________

3. Bank passbooks _______________________________________________________

4. Birth Certificates ______________________________________________________

5. Business agreements ___________________________________________________

6. Deeds, mortgages, etc. _________________________________________________

7. Cemetery plot title _____________________________________________________

8. IRAs, money market, certificates of deposit, and Keogh accounts

______________________________________________________________________

9. Insurance policies _____________________________________________________

10. Marriage certificate(s) _________________________________________________

11. Military serial number and evidence of service ______________________________

______________________________________________________________________

12. Lease agreement(s) __________________________________________________

13. Naturalization papers _________________________________________________

14. Notes and obligations _________________________________________________

15. Safe deposit box(es) __________________________________________________

16. Safe deposit key(s) ___________________________________________________

17. Securities (stocks and bonds) ___________________________________________

18. Social Security number and records ______________________________________

______________________________________________________________________

19. Tax returns for prior years and receipts ___________________________________

______________________________________________________________________

20. Pension and retirement benefits data _____________________________________

______________________________________________________________­________

21. Trust fund(s) records _________________________________________________

22. Veterans' Administration claim number ____________________________________

23. Will ________________________________________________________________

24. Other ______________________________________________________________

Important Names, Addresses, and Phone Numbers

1. Physician ____________________________________________________________

Address _______________________________________________________________

Phone ________________________________________________________________

2. Clergy ______________________________________________________________

Address _______________________________________________________________

Phone ________________________________________________________________

3. Funeral director _______________________________________________________

Address _______________________________________________________________

Phone ________________________________________________________________

4. Attorney ____________________________________________________________

Address _______________________________________________________________

Phone _________________________________________________________________

5. Insurance agent(s) ____________________________________________________

Address _______________________________________________________________

Phone _________________________________________________________________

6. Executor ____________________________________________________________

Address _______________________________________________________________

Phone _________________________________________________________________

7. Accountant __________________________________________________________

Address _______________________________________________________________

Phone _________________________________________________________________

8. Stockbroker __________________________________________________________

Address _______________________________________________________________

Phone _________________________________________________________________