Free Printable End-of-Life Checklist Template
Printable End-of-Life Checklist
[YOUR COMPANY NAME]
[YOUR COMPANY ADDRESS]
[YOUR COMPANY EMAIL] | [YOUR COMPANY NUMBER]
Personal Information
☐ Full Legal Name: Etha Lehner
☐ Date of Birth: July 15, 1980
☐ Social Security Number: 123-45-6789
☐ Contact Information:
-
Phone: 222 555 7777
-
Email: etha@you.mail
Legal and Financial Documents
☐ Will or Trust in Place (Location: Safe Deposit Box at BrandVibe Bank)
☐ Durable Power of Attorney for Healthcare: Dr. Dell Stokes, 222 555 7777
☐ Durable Power of Attorney for Finances: Carmel Ryan, CPA, 222 555 7777
☐ Life Insurance Policy Number: AX-567890123
☐ Digital Assets Log (Social Media, Emails, Passwords): Stored with LastPass Account
Medical Preferences
☐ Advanced Healthcare Directive (Date Signed: January 10, 2051)
☐ Organ Donation Preference: Yes, Donate to research or individuals
☐ Preferred Medical Facility: DynaFive Hospital, Baltimore, MD 21201
☐ Contact for Medical Decisions: Malcolm Raynor, 222 555 7777
Funeral Arrangements
☐ Preferred Funeral Home: MindStove Funeral Services, Jacksonville, FL 32099
☐ Burial or Cremation Preference: Burial at CastleBrand Park
☐ Music or Readings: "Amazing Grace," Psalm 23
☐ Obituary Instructions (Draft Prepared): Yes (Stored in Will Binder)
Communication Plan
☐ Notify the Following Individuals:
|
Name |
Relationship |
Contact Information |
|---|---|---|
|
Porter Hoppe |
Friend |
porter@you.mail |
|
Davion Barton |
Financial Planner |
davion@you.mail |
|
Barry Morar |
Healthcare Proxy |
barry@you.mail |
Call to Action
Take charge of your future today by completing this checklist and sharing it with your trusted contacts. For more guidance, contact [YOUR COMPANY NAME] at [YOUR COMPANY NUMBER] or email [YOUR COMPANY EMAIL].
