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RESIDENT PERSONAL INFORMATION SHEET <br />NAME <br />ADDRESS <br />DATE <br />PHONE <br />EMAIL #1 <br />EMAIL #2 <br />We are requesting the following VOLUNTARY Information in case of an emergency. In case of a medical emergency or if I am incapacitated <br />please call these local contacts <br />NAME PHONE <br />NAME PHONE <br />DOES ANYONE HAVE THE POWER OF ATTORNEY FOR YOU? <br />YFS NO <br />FILE COPY <br />YES NO <br />LIMITED? <br />YES NO <br />UNLIMITED? <br />YES NO <br />NAME <br />FOR WHAT PURPOSE? <br />ADDRESS <br />PHONE <br />WHO IS THE EXECUTOR OR EXECUTRIX OF YOUR ESTATE? <br />ADDRESS <br />PHONE <br />IN THE EVENT OF A MEDICAL EMERGENCY NECESSITATING MY ABSENCE FROM MY APARTMENT, MAY WE RELEASE ITEMS OF <br />PERSONAL PROPERTY TO AN AUTHORIZED PERSON(S)? <br />YES N" <br />AUTHORIZED PERSON #1 i PHONE <br />ADDRESS <br />CITYSTATE <br />AUTHORIZED PERSON #2 <br />PHONE <br />ADDRESS <br />CITY/STATE <br />PRIMARY PHYSICIAN <br />PHONE <br />CHURCH AFFILIATION <br />PHONE <br />DOES OR WILL ANYONE HAVE A KEY TO YOUR UNIT BESIDES YOU? <br />YES \O <br />NAME <br />PHONE <br />NAME <br />PHONE <br />CAR YEAR/MAKE/MODEL <br />LISCESE PLATE # <br />CAR YEAR/MAKE/MODEL <br />LISCENSE PLATE # <br />CAR YEAR/MAKEiMODEL <br />LISCENSE PLATE # <br />CAR YEAR/MAKE/MODEL <br />LISCENSE PLATE # <br />SIGNE: <br />LtiITNESSED <br />