Death or Incapacity
Instructions and Information1
as of May 1, 2013


Personal/Vital Information

Name: Thomas Lee Larsen. Date of Birth: Xxxxxxxx XX, 1949. Place of Birth: Xxxxx xx Xxxxxx Hospital, Los Angeles, California. Mother’s Maiden Name: Xxxxxxxxx. Religion: Roman Catholic. Social Security Number: XXX-XX-XXXX. California Driver’s License Number: XXXXXXXX. Home Address: 14844 Wyandotte St., Van Nuys, CA 91405-1823. Home Telephone Number: (818) 785-4553. Spare keys to the house are under xxxx xxxxxx at the base of a xxxx that is at the xxxxxxxxx corner of the xxxx xxxx. I have a xxxx xxxxxxx xxx at Xxxx xx Xxxxxxx, XXXX Xxxxxxxxx Xxxx., Xxx Xxxx, CA XXXXX, (818) XXX-XXXX, Xxx X XXX. Xxxx xx xxxxxxxxxxxxx xxxx xx Xxxxx 3xx xxx xx xx xxxxxxxx xxxxxxx. The xxx contains two xxxxxx xxxx xxxxxx which are xxxxxxxxxx of xxxxxxx I travel with. I was given xxx xxxx. (The location of these xxxx are in my computer file titled “Storage-RV-Trailer Contents.doc” located on my Macintosh G3 PowerBook laptop computer (black in color) in the folder “Macintosh HD/Documents/Word Data Logs/Word Data Travel.”) Xxxxxxx Xxxxxx: Xxxxx Xxxxx Xxxx Xxxxxxx, XXX X. Xxxxx Xx. (xxxxx of Xxxxxxxxxx XX between Xxxx XX and Xxx. XX on the xxxxx xxxx of the xxxxxx at xxxxx xxxxxxxxxxx xxxx xxxxxx XXXXX XXXXX X. X. XXXX & XXXX XXXXXXX), X.X. Xxx XXXX, Xxxxxxxxxx, XX XXXXX, (XXX) XXX-XXXX and (XXX) XXX-XXXX, XXXXX X XXX. (XXX xxxxxxxxxxx: Xxxxxxxx XX° XX' XX.X" Xxxxx, Xxxxxxxxx XXX° XX' XX.X" Xxxx; or XX° XX.XX' Xxxxx, XXX° XX.XXX' Xxxx; or XX.XXXXX° Xxxxx, XXX.XXXXX° Xxxx) I Xxx xxxx xxxxxx on Xxxxx 1xx. It is xxxxxx with a Xxxxxx xxxxxxx (supplied by me) using xxx xxxxx number XXX, xxx xxxx XXXXXX. Additionally, the xxxxxxx company supplied a Xxxxxxx Products xxxxxxx xxx (xxxxxxxx) xxxxxxx xxxx. (The location of these xxxx are in the same computer file I mention above.) My certified Birth Certificate and other vital statistics documents are in the garage at home in a cardboard box labeled EB1 (east xxxxxxx xxxx, 2nd shelf down, box # 1). Another certified copy of my birth certificate is in the trailer in storage container Left B 5. My Passport and Passport Card are in the trailer in storage container Left B 5.

Health/Medical Information

My Doctor’s name is David McIntosh, M.D., Northeast Valley Health Corporation, 12756 Van Nuys Blvd., Pacoima, CA 91331-1626, (818) 896-0531. My Member ID Number there is: 07-4084-0181 and my Chart Number is: 0324615. My Dentist’s name is: Alain G. Gabbay, D.D.S., 6400 Van Nuys Blvd., Van Nuys, CA 91401, (818) 988-5722. My height is 6' 3". My weight is about 185 lbs. My blood type is A+. I had a kidney stone in my left kidney in August 1992 which was broken up with Extracorporeal Shock Wave Lithotripsy (ESWL). In August 2000 I was diagnosed with Atrial Fibrillation after having heart palpitations for several years. For this condition I was under the care of cardiologists at Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA 91342-1495, (818) 364-1555. My MRUN (Medical Record Number) there is: 241-21-05. They performed Cardioversion and Ablation and both were unsuccessful. A more advanced ablation procedure called CartoXP was performed in October 2005 by private cardiologist John P. McKenzie, III, M.D., 660 W. Broadway, Glendale, CA 91204-1008, (818) 502-9420. Two days after the procedure my heart began beating rapidly and continued until Dr. McKenzie performed the CartoXP procedure a second time in March 2006. This time it was successful and I was removed from all medications. Despite having skipped beats on occasion, Olive View cardiologists are not concerned and released me from routine follow-up appointments in February 2009. Other than those conditions listed above, I’ve had no serious illnesses in my life. I do have some low back pain and post-nasal drip though, but they are minor problems. I do use non-prescription reading glasses. I have no other chronic or acute illnesses. I am taking over-the-counter vitamins, minerals, various supplements, and high protein. (All these supplements are itemized in detail in my computer file titled “Vitamins & Supplements.doc” located in the folder “Macintosh HD/Documents/Word Data Health & Fitness.”) I am not allergic to any medicines, medications, antibiotics, or foods. I am not infected with any diseases. I tested HIV & STD negative on November 22, 2011 and do not engage in risky behavior any longer. Other than minimal experimenting years ago, I have never smoked cigarettes or taken illegal drugs although my mother smoked while pregnant with me and both parents smoked moderately heavy during the first 11 years of my life. I seldom drink alcoholic beverages. I have no health, dental, or life insurance.
If I am gravely ill or deceased please call a Catholic Priest to administer Last Rites. I was Baptized (as a baby) and Confirmed (at about age 11) at St Elizabeth Catholic Church, 14655 Kittridge St., Van Nuys, CA 91405, (818) 779-1756 but do not attend Mass regularly. My chosen Confirmation name was Leon. I graduated from Van Nuys High School in June 1968 and have taken some college classes while in prison. My Baptismal Certificate is in the above-mentioned cardboard box – EB1.
If disease, illness, or accident causes me to be kept alive by a machine and there is little hope of improvement my wishes are to be disconnected and left to die naturally. During that process I wish to receive medication only to relieve pain. I do not wish to donate any organs or tissues. I have not made arrangements for anyone to make these decisions for me. (See Last Will and Testament section below for who I appoint.) If and when the time comes consider this signed and dated 5-page document your authorization to carry out my wishes. I waive any requirement(s) for that person or organization to have a bond.

Family/Friends/Relationships

I am not in the military and have never been. I am not married and have never been. I am gay. I am currently not involved in a relationship and live alone. I do not have, and have never had, any children. (I have never even had sexual intercourse with a woman.) My parents, Ernest C. and Marie M. Larsen, had no other children besides me. They are both deceased. I have no known family in the Los Angeles area (where I have lived for all my life other than those times when I was incarcerated) and have not communicated with most out-of-state relatives for decades. (Those few who I have communicated with around the mid-1990s I am on the outs with as detailed below.) I have no close friends and those few who I am on friendly terms with know me in a very limited superficial way. I am not employed and am not in business with anyone or self employed. I regularly exchange letters with (and occasionally visit) an inmate at the California Substance Abuse Treatment Facility at Corcoran, California. His name and current address is: Xxxxxxx Xxxxxxx, EXXXXX, XX-X-XXXUp, P.O. Box XXXX, Xxxxxxxx, CA 9XXXX-XXXX. Please notify him if something happens to me.

Personal Property/Financial Information

I own the home listed above along with all the belongings inside and outside of it except 3 items as listed below. It is fully paid for. It is not insured. The deed to the house is in the above-mentioned cardboard box – EB1.
I own a 1998 Winnebago 24-foot Class-C motorhome, California license number 1UAU453; a 2006 16-foot long utility trailer, California license number 4HE8960; a 1971 Chevy van, California license number 1KHY362; and a 1975 Honda ST90 motorcycle, California license number 5L2879. They are all fully paid for. The Winnebago motorhome is insured by Xxxxxxxx Insurance Xxxxxxx, policy number XXX-XXXXXXXXXX-XX. The other three are not insured. The Certificate of Titles to these vehicles are in the above-mentioned cardboard box – EB1. The Xxxxxxxx insurance policy is in a gray plastic file cabinet located on the cab-over bed of the motorhome. Keys to the motorhome, trailer, and motorcycle are in the large bookcase in my bedroom. Keys to the van are on the round table with the tan table cloth in the living room and spare keys to it are in a kitchen cabinet.
I have a checking account at Xxxx xx Xxxxxxx, account number XXXX-XXXX-XXXX. With this account I have a Debit Card with which I can withdraw money from ATMs. Its account number is XXXX XXXX XXXX XXXX. I have a Traditional IRA at Xxxx xx Xxxxxxx, account number XXX-XXX-XXXX-XXXX. The rest of my money is diversified among various stocks and bonds and handled by two investment firms: Xxxxxxx, Xxxxxx & Xx., XXXX Xxxxxxx Xxxxxx Xxxx, Suite XXX, Xxxxxxxx Xxxxxxx, CA XXXXX-XXXX, (818) XXX-XXXX, (805) XXX-XXXX, (800) XXX-XXXX, Fax (818) XXX-XXXX. My Account Executive there is; Xxxxxx X. Xxxxxxxx. My account number there is XXXXXXXX. The other firm is: Xxxxxx Xxxxxxx Xxxxx Xxxxxx, XXX N. Xxxxx Dr., Suite XXX, Xxxxxxx Xxxxx, CA XXXXX-XXXX, (310) XXX-XXXX, (800) XXX-XXXX, Fax (310) XXX-XXXX. My Financial Advisor there is; Xxxxx Xxxxx Xxxx, (310) XXX-XXXX, (800) XXX-XXXX (X XXXX), Fax (310) XXX-XXXX. My account number there is XXX-XXXXXX. All these accounts are itemized in detail and updated monthly in my computer file titled “Investment Portfolio 20xx.xls” located in the folder “Macintosh HD/Documents/Excel Data Finance/Investment Portfolio.” My current year monthly statements from these firms are in another gray plastic file cabinet next to the above-mentioned one on the cab-over bed of the motorhome. They are also downloaded and placed in my folder at “Macintosh HD/Documents/Financial Statements/20xx.” My Xxxx xx Xxxxxxx check register is in my computer file titled “Check Register (xx - xx).xls” located in the folder “Macintosh HD/Documents/Excel Data Finance/Check Register.” My tax returns beginning in 2006 are in my folder at “Macintosh HD/Documents/Financial Statements/20xx.” Related paperwork for the most recent four years are in the trailer in storage container Right B 3. Years farther back (as far back as 1993) are in cardboard boxes labeled EA9, EA4, & in a Rubbermaid blue container to the north of the middle shelves.
Other than what is listed above, I own no other real estate, vehicles, or assets.
The following items belong to my pen pal friend, Xxxxxxx Xxxxxxx: An envelope containing postage stamps with a note saying, Stamps belonging to Xxxxxxx Xxxxxxx. It is in the above-mentioned gray plastic file cabinet that contains my monthly statements and is in a folder named “Xxxxxxx Xxxxxxx.” I also have cash of his deposited in my checking account. Each month I print out a page called Monthly Entries on which I track my expenses. On the lower right of that page I have a section called Xxxxxxx Xxxxxxx’x Petty Cash. That amount is his. This page is in the above-mentioned gray plastic file cabinet that contains my monthly statements and is in a folder named “Investment Portfolio.” If something happens to me ask him where he wants this stuff sent.
I have no outstanding debts and always pay bills and credit card payments in full and on time every month. I have three Master Cards: “XXXX Xxxxxxxxx Xxxx Xxxxxxxx,” Account number XXXX XXXX XXXX XXXX; “XX Xxxx,” Account number XXXX XXXX XXXX XXXX; and “Xxxxxxxx Xxxxxxx Xxxxxxxxx,” Account number XXXX XXXX XXXX XXXX. I also have one Visa card: “Xxxx xx Xxxxxxx Xxxxxxxx Xxxx,” Account number XXXX XXXX XXXX XXXX. And I have a Xxxxx Xxxx: “Xxxxx xxx Xxxx,” Account number XXX XXX XXX XXXXX. I have no other credit cards. Further credit card details are contained in my computer file titled “Wallet Cards.doc” located in the folder “Macintosh HD/Documents/Word Data Gen.” My monthly statements from these credit card companies are downloaded and placed in my “Macintosh HD/Documents/Financial Statements/20xx” folder. I am able to pay my credit card bills by going to their individual Web sites and electronically transferring funds from my Xxxx xx Xxxxxxx checking account to their accounts. Their URLs, login names, and passwords are contained in my computer file titled “Logins & Passwords.doc” in the folder “Macintosh HD/Documents/Word Data Computer.” The XXXX, XX, Xxxxxxxx, and Xxxxx credit card companies no longer send paper statements in the mail. I must go to their Web sites monthly to download them. My Macintosh G3 PowerBook (black in color), 2 G4 PowerBooks (titanium in color), and G3 iBook (blueberry in color) computers are all set up to log on to my Earthlink dial-up internet account. My one G4 PowerBook is set up to log on to my Verizon EVDO internet account.
Many of the computer files I mention within these pages have also been uploaded to the internet and are in a password-protected disk image file. Go to:
http://xxxxxxxx.xxxxxx.xxx/xxxxxx.dmg.zip to download the file. This can be done on any internet-connected computer, but only a Macintosh computer using OS X 10.2.8 or later can open the dmg (disk image) file. To do so double-click on it to unzip it then double-click again on the dmg file and when the dialog box asks for the Password enter “xxxxxxxxxxxxxxx” (without the quotes). Drag the folder in the disk image called “upload” to your hard drive. Most of the files in “upload” can be read on a Macintosh or Windows computer using Microsoft Word (.doc) and Microsoft Excel (.xls). The other files are HTML files and will open in any Web browser.

Burial Instructions

I have a burial plot at San Fernando Mission Cemetery and Mausoleum, 11160 Stranwood Ave., Mission Hills, CA 91345-1199, (818) 361-7387, Fax (818) 365-6187. My plot is located in Section BB, Tier 18, Single Grave Site # 144 next to my parents in Sites 142 & 143. The account is in my father’s name, Ernest C. Larsen. It is fully paid for along with a gravestone marker. Various burial services are not paid for. I do not want to be cremated. The contract and all paperwork relating to the plot’s purchase are in a blue folder in the above-mentioned cardboard box – EB1. I have not made arrangements for anyone to handle my affairs after my passing. (See Last Will and Testament section below for who I appoint.) When the time comes consider this signed and dated 5-page document your authorization to handle my affairs. I waive any requirement(s) for that person or organization to have a bond.

Last Will and Testament

The only Will I have ever made is a completely handwritten in blue ink holographic 1-page document dated May 1, 2013. It is located in the top-center drawer of the desk in my bedroom (where an original of this signed and dated 5-page document is attached). There are no codicils. In it I declare that I leave my entire estate (after taxes, burial, and other expenses are paid to the proper recipients) to the International Bird Rescue Research Center (4369 Cordelia Road, Fairfield, CA 94534, (707) 207-0380, Fax (707) 207-0395, E-mail info@ibrrc.org, http://www.ibrrc.org/) for its general purposes to aid them in whatever ways they see fit at any of their facilities. (They have not been told in advance of my intended gift. I appoint the person who is the Executive Director at the time of my passing or incapacity to handle my affairs and carry out my wishes, although I grant the Executive Director permission to delegate that responsibility to another person of his or her choosing. If this person is hesitant to handle the affairs of someone they do not know let them know it is required in order to get my estate which is in the million dollar range. If they still decline then I give the authorities that are handling my body wherever I die permission to choose an organization that helps animals [non-human only] and ask them if they wish to handle my affairs in order to get my estate.) I specifically decline to leave anything to any family members, be they on my mother’s side or father’s side of the family. This is because certain property was stolen from the house and money was taken from my accounts for unauthorized uses when I was in federal prison at the time of my parents’ passing and relatives from both sides of the family had access to it. Three of them (my father’s sisters; Myrtle Christell & Florence Jensen, and my cousin [the son of my mother’s brother]; Mark Xxxxxxxxx) were told in an 18-page letter dated April 24, 1998 that both sides of the family would inherit nothing unless certain reparations were made. I received a letter from Mark confirming receipt of my letter and spoke to Myrtle on the phone about it. Neither has offered up any compensation; therefore, the families — all members — are left out. That 18-page letter is on my computer titled “Inquiry Letters” in the folder “Macintosh HD/Documents/Word Data Books/Word Data Fedbuster.” The “Inquiry Letters.doc” file contains other letters (from page 19 on) addressed to other people unrelated to my estate wishes.

Whoever handles these final affairs for me is authorized to receive from my estate just compensation. In order to take care of expenses incurred before the estate is settled, that person is authorized to use my three Master Card credit cards and Xxxx xx Xxxxxxx Visa and ATM cards. The credit cards can also be used to withdraw cash from ATM machines. The three Master Cards and ATM card use the same PIN; XXXX. The Visa PIN is; XXXX. I have also pre-signed several Xxxx xx Xxxxxxx checks for this purpose. I also have check-writing privileges on my Xxxxxxx, Xxxxxx account (called Xxxxxxx Money Market) and several checks from it have also been signed. (see page 15 of my “Investment Portfolio 20xx.xls” for current Xxxxxxx, Xxxxxx balance.) The two checkbooks are located in the same gray plastic file cabinet which contains the above-mentioned monthly statements. I waive any requirement(s) for that person or organization to have a bond. This document and Will are valid wherever I die domiciled.


Signed in blue ink this________________day of_______________________________
in Van Nuys, California, Los Angeles County
I declare under penalty of perjury that everything I say, write, or type is true and correct.



Thomas Lee Larsen
14844 Wyandotte St.
Van Nuys, CA 91405-1823
(818)785-4553


_____________________
1 Three originals of this computer-printed 5-page document exist: a reduced-size (3-pages long) version carried in my wallet with sensitive information Xed out; a Web version on the internet at: http://tlarsen2.tripod.com/will.html with sensitive information Xed out; and a full-size version located in the top-center drawer of the desk in my (east) bedroom (where an original of a signed and dated completely handwritten in blue ink holographic one-page Will is attached) with all information visible. (The Web version has a typed out version of the one-page Will included.)





May 1, 2013

         My name is Thomas Lee Larsen. I being of sound mind and body make this completely handwritten in blue ink one page my last Will and Testament. There are no codicils. I wish to leave my entire estate to the International Bird Rescue Research Center for its general purposes to aid them in whatever ways they see fit at any of their facilities. I specifically decline to leave anything to any family members, be they on my mother’s side or father’s side of the family. Further important details and instructions are included in the attached signed and dated 5-page computer-printed document titled “Death or Incapacity Instructions and Information as of May 1, 2013.” This Will and that document are valid wherever I die domiciled.

Signed this 1st day of May, 2013
in Van Nuys, California, Los Angeles County.
I declare under penalty of perjury that
everything I say, write, or type in these
documents is true and correct.
Thomas Lee Larsen
14844 Wyandotte St.
Van Nuys, CA 91405-1823
(818) 785-4553