Estate Planning Form

Instructions: This is a general questionnaire designed to be applicable to as many people as possible. Some aspects of the questionnaire are likely to not apply to your specific situation so please ignore the sections not applicable to you. At the end of the questionnaire is a text box where you may inform of us of your particular circumstances if you so choose. You may complete this form by hand and mail or fax to our office or online and submit by e-mail.

Today's Date

Your Name

Phone Number

Email Address

Marital Status

Date of Marriage

Husband's Information

Name

AKA

Street

City

State

Zip

Phone

Date of Birth

Citizenship

Wife's Information

Name

AKA

Street

City

State

Zip

Phone

Date of Birth

Citizenship

Estate Division

Briefly describe the manner in which you desire your estate be divided among your children and/or other beneficiaries: (We will discuss this area in greater detail during our initial office meeting)

State any specific gifts of money or property such as personal items, the recipients of any such gifts, your relationship to the recipient, and the amount of money or property to be given to each recipient: (We will discuss this area in greater detail during our initial office meeting)

Children of the Marriage

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

Husband's Children of Prior Relationship

Name

Date of Birth:

Name

Date of Birth

Name

Date of Birth

Wife's Children of Prior Relationship

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

If any of the children are disabled, list public benefits received in the box below:

If any of the children are stepchildren or foster children, are they to be treated as children under your testamentary plan?

Successor Guardians of Minor Children

First Successor Guardian of Minor Children

Alternate Successor Guardian of Minor Children

Trustees, Executors, and Fiduciaries

First Successor Agent

Address

City

State

Zip Code

Alternate Successor Agent

Address

City

State

Zip Code

Advance Healthcare Directive (Living Will)

Husband

Do you prefer life sustaining treatment beyond the time medical doctors advise your family that there is no chance of regaining consciousness?

Do you want your doctors to provide pain medication even if doing so might hasten your death?

Do you want to donate your organs upon your death?

Wife

Do you prefer life sustaining treatment beyond the time medical doctors advise your family that there is no chance of regaining consciousness?

Do you want your doctors to provide pain medication even if doing so might hasten your death?

Do you want to donate your organs upon your death?

Please provide any additional information you believe may be pertinent to your estate planning goals:

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