Planning Ahead - Florida Developmental Disabilities Council

PROTECTING LEGAL RIGHTS AND FINANCIAL STATUSThis section describes the financial arrangements that have been made to benefit the person andprotect legal rights. Be sure that the names of any financial advisors are included as well as copiesof court orders or other legal papers.Person needs assistance with:Banking Paying Bills Making Purchases Counting Money Recognizing Denominations of MoneyFinancial Safeguards:Two Signature Checking Accounts Representative Payee A TrustOther (Describe):Name of Trust:This trust is: Revocable Special Needs IrrevocableTRUSTEES NAME(S) ADDRESS(ES) PHONE NUMBER(S)CurrentSuccessorsCopy of the trust can be found:POWER OF ATTORNEYHas power of attorney been given to anyone: Yes No Limited DurableIf Yes, Name:Phone Number:Address:REPRESENTATIVE PAYEEDoes a representative payee receive benefits for the person? Yes NoName:Phone Number:Address:Does the person receive? Yes/No Amount Per MonthA pension / retirement income?Trust incomeSocial Security benefitsSupplemental Security incomeOther benefits / income (specify):Section 2, The Personal Information Section75