URS Health Benefits
Print and fill out this form. Give copies to your spouse, a close relative, your executor and attorney. Update this information periodically. Printed copies of this form are available at Utah Retirement Systems.
If you need more room to list certain details, staple a separate sheet to this locator. Do not use a paper clip.
Name: Social Security Number:
| Location A: | Location C: |
| Location B: | Location D: |
Itemized list of valuable property and important papers. Circle the location of each item.
| Location | Wills and Estate Papers | Location | Retirement Plan Documents |
| A B C D | My Will (original) | A B C D | 401(k), 457, 403(b), IRA, etc. |
| A B C D | My Will (copy) | A B C D | Military, Other Public or Private Plans |
| A B C D | Spouse's Will (original) | A B C D | |
| A B C D | Spouse's Will (copy) | Financial and Legal Affairs | |
| A B C D | Trust Agreements | A B C D | Tax Files |
| A B C D | Power of Attorney | A B C D | Titles (Car, Boat, etc.) |
| A B C D | Living Will/Medical P.O.A. | A B C D | Mortgages, Notes |
| A B C D | Birth Certificate | A B C D | List of Checking, Savings and Other Accounts |
| A B C D | Marriage Certificate | A B C D | List of Credit Cards and Accounts |
| A B C D | Divorce/Separation Papers | A B C D | List of Stocks, Bonds, Mutual Funds, other investments |
| A B C D | Military Papers | A B C D | Employment/Business Agreements |
| A B C D | A B C D | ||
| A B C D | A B C D | ||
| A B C D | Funeral and Burial Instructions | Property and Other | |
| Insurance Policies | A B C D | Keys to Home, Car, Buildings and Other Locks | |
| A B C D | Life | A B C D | Safety Deposit Box and Keys |
| A B C D | Health | A B C D | Safe Combination |
| A B C D | Homeowner | A B C D | List of Stored and Loaned Properties |
| A B C D | Car, Boat, etc. | A B C D | |
| A B C D | Funeral Plan | A B C D | |
| A B C D | A B C D |
Safe Deposit Box Location:
Other Location information:
| Financial Accounts (Detail) | Important Names, Addresses and Telephone | ||
| Account Name | Account Number | Numbers for Estate Settlement | |
| Retirement Plan | |||
| Attorney | |||
| Insurance Agent | |||
| Accountant/Tax Preparer | |||
| Other | |||
| Other | |||
| Other | |||
| Copies Given to: | Date Prepared: |
This locator courtesy of Utah Retirement Systems