VITAL INFORMATION
FULL NAME:
DATE AND PLACE OF BIRTH:
________________________________________________________________________________________________________SOCIAL SECURITY NUMBER:
________________________________________________________________________________________________________RANK:
________________________________________________________________________________________________________DATE RETIRED FROM FIRE DEPARTMENT:
________________________________________________________________________________________________________F.D. PENSION NUMBER:
________________________________________________________________________________________________________TYPE OF RETIREMENT: (check one)
___SERVICEHEALTH INSURANCE PLAN:
________________________________________________________________________________________________________HEALTH PLAN NUMBER:
________________________________________________________________________________________________________MILITARY SERVICE RECORD:
BRANCH OF SERVICE:
________________________________________________________________________________________________________SERVICE SERIAL NUMBER:
________________________________________________________________________________________________________DATES ON ACTIVE DUTY:
________________________________________________________________________________________________________“C” CLAIM NUMBER: (If you ever filed a VA claim)
________________________________________________________________________________________________________MILITARY DISCHARGE SERVICE PAPERS: (Where Kept)
________________________________________________________________________________________________________LOCATION OF IMPORTANT DOCUMENTS
LIST WILL AND TESTAMENT:
________________________________________________________________________________________________________MARRIAGE CERTIFICATE BIRTH CERTIFICATE:
________________________________________________________________________________________________________SPOUSE BIRTH CERTIFICATE:
________________________________________________________________________________________________________BIRTH CERTIFICATE FOR EACH CHILD (Dependent):
________________________________________________________________________________________________________ADOPTION PAPERS:
________________________________________________________________________________________________________INSURANCE POLICIES:
________________________________________________________________________________________________________CREDIT CARDS/CASH ADVANCE (Covered by Life Insurance):
________________________________________________________________________________________________________ ________________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________BANKS & ACCOUNT BOOK NUMBERS:
________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________SAFE DEPOSIT BOX NUMBER & BANK:
___________________________________________________________________________KEY FOR SAFE DEPOSIT BOX (Where Kept):
________________________________________________________________________________________________________SECURITIES & CERTIFICATE NUMBERS:
________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________TRUST INSTRUMENTS:
________________________________________________________________________________________________________TITLES TO AUTOMOBILES:
________________________________________________________________________________________________________TAX RETURNS FOR PRIOR YEARS:
________________________________________________________________________________________________________DEEDS, MORTGAGES, OTHER LEGAL DOCUMENTS: Covered by Life Insurance?
________________________________________________________________________________________________________LOAN NOTES & OTHER FINANCIAL OBLIGATIONS: Covered by Life Insurance?
________________________________________________________________________________________________________BUSINESS AGREEMENTS:
________________________________________________________________________________________________________TITLE TO CEMETERY PLOT ATTORNEY TO CONTACT:
________________________________________________________________________________________________________ACCOUNTANT OR TAX CONSULTANT TO CONTACT:
________________________________________________________________________________________________________AFFILIATED PARTICIPANT OF THE ANNUITY FUND OF THE UFOA:
________________________________________________________________________________________________________NYC 457 PLAN OR OTHER DEFFERED COMPENSATION PLAN:
________________________________________________________________________________________________________PENSION BENEFITS FROM SECOND EMPLOYMENT (401K, Profit Sharing, etc.):
________________________________________________________________________________________________________INDIVIDUAL RETIREMENT ACCOUNT (IRA:)
________________________________________________________________________________________________________KEOUGH PLAN FOR SELF EMPLOYMENT:
________________________________________________________________________________________________________NAMES AND ADDRESSES OF ALL TESTAMENTARY HEIRS AND BENEFIT DESIGNATED BENEFICIARIES. OTHER IMPORTANT INFORMATION THAT SHOULD BE KNOWN BY YOUR SURVIVORS:
________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________FAMILY DOCUMENTS SHOULD BE KEPT WHERE THEY ARE PROTECTED FROM FIRE AND THEFT, YET READILY AVAILABLE. CLAIMS FOR BENEFITS MAY REQUIRE DETAILED SUPPORT OR EVIDENCE FROM THESE DOCUMENTS. OTHER IMPORTANT PAPERS MEMBERS AND THEIR FAMILIES SHOULD SAFEGUARD INCLUDE SEPARATION PAPERS, DEATH CERTIFICATES, DIVORCE DECREES AND GUARDIANSHIP OR CHILD CUSTODY EVIDENCE