Name:___________________________________________________ Birth Date _____________

Address: _______________________________________________________________________

_____male ______female

___married ____ once____ several ______widow(er) _____divorced _____single

Telephone number(s):_________________________________

E-Mail #:___________________________________________

Name of spouse:______________________________________

Children: __NONE _____1 _____2 ______3 _____4 Other:______

______more children are anticipated
______no child, but children are anticipated
Adopted children are to be ____expressly included, ____expressly excluded or ____this Will is to be silent on the subject.
Name(s) of Children and ages:
______________________________ _______________________________
______________________________ _______________________________
______________________________ _______________________________

Approximate assets of the testator: $__________________

Real Estate Owned: _____________________________________________________

How Held: Jointly_______________ Sole Owner__________

Property To Be Sold At time of Death?:_______

How are the personal effects and other tangible personal property to be bequeathed?

________all to the spouse
________all to the children
________as provided with regard to the residuary estate
________all to one beneficiary (enter name):_____________________________
________OTHER (describe disposition and shares): ____________________________________________________________________________________________________________________________________
The rest of your estate is to be distributed as follows -

______all to my spouse outright
______if my spouse dies before me I give the rest of my estate to:
my children_______________
other:_______________________________________________
_______________________________________________
______a minimum bequest to spouse (disinheriting spouse to the
extent permitted by law) [balance to ______the children or
______other beneficiaries (list):
_______________________________________________________
______to my children and their issue
______to one beneficiary outright
______to more than one beneficiary, in ____equal or ____unequal shares, either
Enter any specifics: _________________________________________________
_________________________________________________________________

A beneficiary is to be deemed a "minor", whose legacy should be held in trust, if he is under the age of -
_____18 _____19 _____21 _____25

If a child of the testator is a minor, are bequests to the child to be -
______held in trust [by ____a TRUSTEE or ______the executor] until
child attains majority

Appoint as executor:

____ my spouse _______________________________________________________

_____other executor ____________________________________________________

_____ Do you want a backup executor_____________________________________________
************************************************************************
IF THERE IS TO BE A TRUST -
_____one trustee?
_____one trustee and one or more successor trustee?

Enter the name(s) of the trustee(s) and relationship to the testator:
_______________________________________________________
_______________________________________________________
_____a trustee is also a beneficiary (if so, you should have a
co-trustee)

_____create a single trust, rather than separate trusts, for
minor children (permitting unequal payments)

_____if a minor grandchild becomes a beneficiary, bequest must
be held in trust

_____trustee may liquidate a trust for a minor to the minor's guardian

If there are minor children, do you wish to appoint:
_____one guardian
_____one guardian plus a back-up guardian
_____no guardian is to be appointed in this Will

Enter the name(s) of the guardian(s) and relationship to testator:
____________________________________________________________
____________________________________________________________

ANCILLARY DOCUMENTS:

__"Living Will" (withdrawing medical treatment if the
testator is terminally ill) Enter names, addresses and
telephone no. of agent or agents (including the spouse) to act
if testator is incapacitated:

Name:________________________________________________

Address:______________________________________________

Phone:________________________________________________

Back-Up:______________________________________________

______________________________________________

______________________________________________

_____Funeral arrangements -

____cremation _____die at home ____ medical or scientific purposes
____buried with military honors ____no mention

Durable Power of Attorney:
_______ effective upon disability in the future
_______ effective immediately

Names and address(es) of person(s) to be appointed for Power of Attorney:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

______ Successor Attorney-in-Fact? _______ Co-Attorney? _______
__________________________________________________

__________________________________________________

Return to Homepage