ORGANIZATIONS AND SERVICES TO BE NOTIFIED

UPON DEATH AND ACTIONS TO BE TAKEN

Many organizations we belong to (churches, health clubs, country clubs, civic, etc.) or services we
subscribe to (lawn services, insect control, credit reporting alerts, Angie's list, etc.) must be
notified of our deaths to not only cancel memberships and services but to stop automatic renewals
if they have a credit card or bank draft on file. Even if the cards are cancelled and bank accounts
are frozen after death, if the services aren't actually cancelled, they may be able to make a claim
against your estate. In addition, in the case of memberships in clubs, there may be a locker that
needs to be cleaned out or similar requirements. Please list all organizations that should be
notified of your death and how to contact them as well as provide the information needed for
others to cancel any memberships, service accounts, etc. as well as list any additional action that
may be required like cleaning out lockers.

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

ORGANIZATIONS AND SERVICES TO BE NOTIFIED UPON DEATH AND ACTIONS TO BE TAKEN

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Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

Name of Organization:
Contact Information:
Membership No. or Service Agreement No.:
Password, User Name or Other Data Needed to Cancel:
Further Action to be Taken and Information Needed to Take Action:

(PRINT OUT ANOTHER NOTIFICATION FORM IF YOU NEED TO ADD MORE NAMES)

ORGANIZATIONS AND SERVICES TO BE NOTIFIED UPON DEATH AND ACTIONS TO BE TAKEN

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