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

prior written permission.

Organization Financial Affairs

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

1. Sources of income:

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

Amount Additional information

2. Valuables (art, jewelry, etc. and their estimated values, insurance on

item, etc.): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

prior written permission.

3. Current professional contact information

Professional Name Address Phone

Accountant

Notary

Attorney

Financial advisor

Stockbroker

Insurance agent

4. Banking Power of Attorney:

Your bank/financial institution may have a specific form they need completed for another person to have financial power of attorney.

Institution Account # Contact Phone number

Address

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

prior written permission.

5. Power of Attorney/Mandate/Durable Power of Attorney – intended for

use when parent is incapacitated

Prepared by: ______________________________________________ Phone number: ____________________________________________ Address: _________________________________________________ Date: ____________________________________________________ Location of original: _________________________________________ People who also have copies: (this should include your loved one’s primary physician and all people who are designated agents) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Other: ____________________________________________________

6. Will:

You should obtain a copy and put it in a safe place. a. Drafted by (name, address, phone):

__________________________________________________________________________________________________________

b. Drafted on date: ________________________________________ c. Location of original: _____________________________________ d. Executor contact information (name, address, phone)

i. ________________________________________________________________________________________________

ii. ________________________________________________________________________________________________

iii. ________________________________________________________________________________________________

7. Trust agreements:

You should obtain a copy and put it in a safe place. a. Drafted by (name, address, phone):

__________________________________________________________________________________________________________

b. Drafted on date: ________________________________________ c. Location of original: _____________________________________ d. Other important details:

_______________________________________________________________________________________________________________________________________________________________

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

prior written permission.

8. Location of most recent tax return: ___________________________________________________________

Accountant contact information: ______________________________________________________________________________________________________________________

9. Bank accounts:

Institution Account # Checking or Savings

Contact Phone number

Address Pin number

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

prior written permission.

10. Retirement, investments, pension:

Institution Account # Address Contact Phone

11. Day to Day finances:

Institution, provider, contact

Amount Account # Phone number

Mortgage

Home insurance

Rent

Phone THIS

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

prior written permission.

Institution, provider, contact

Amount Account # Phone number

Electric

Water

Gas

Cell phone

Car

Car Insurance

Taxes

Taxes

Taxes

Taxes

Credit card

Credit card THIS

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

prior written permission.

Institution, provider, contact

Amount Account # Phone number

Loans

12. Liabilities

Money owed To whom For what Payment details

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

prior written permission.

13. On-line banking or other information

Computer sign on: User name: _____________________ password: __________________

Email used Account Password Additional instructions:

14. Other notes or additional instructions: ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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