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Will Questionnaire
Please use the following form to securely submit the information to prepare your will.
*Information and documents submitted via this form are encrypted prior to transmission.
Step 1 of 3
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Name
First
Middle
Last
Marital Status
Married
Single
Divorced
Do You Have Children?
Yes
No
Spouse's Name
First
Middle
Last
Address
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Children
Child's Name
Child's Age
Estate Management Team
Executor
First
Last
Alternate Executor
First
Last
Trustee
First
Last
Alternate Trustee
First
Last
Guardian For Minor Children
First
Last
Alternate Guardian
First
Last
Beneficiaries
Specific Gifts to Organizations
If you want to make a gift (cash or a specific item) to a charity, foundation, religious or fraternal organization, enter them below (not required).
Organization's Name
Gift
Specific Gifts to Individuals
If you want to give specific items or cash gifts to a family member or other individual, enter them below (not required).
Person's Name
Gift
Entire Estate to Your Spouse?
Do you want your spouse to receive the rest of your estate after these special gifts have been distributed?
Yes
No
Residual Beneficiaries
Who do you want to receive the rest of your estate after these special gifts have been distributed?
Person's Name
Percent of Estate
Alternate Residual Beneficiaries
Who do you want to receive the rest of your estate if your primary residual beneficiaries are no longer living?
Person's Name
Percent of Estate
Distributions to Minors
If a minor is to receive an inheritance, at what age should he or she receive the inheritance?
Age of First Distribution
Percentage of Estate
Age of Second Distribution
Percentage of Estate
Age of Third Distribution
Percentage of Estate
Special Instructions for Health Care
Health Care Agent
Do you want to appoint someone to make health care decisions for you when you are unable?
Yes
No
Health Care Agent's Name
First
Last
Alternate Health Care Agent's Name
First
Last
Do You Want a Living Will?
A Living Will makes your wishes known to family and doctors regarding life support and the following decisions in the event you become terminally ill or injured with no hope for recovery.
Yes
No
End of Life Decision
I do not wish to artificially prolong the process of my dying if continued health care will not improve my prognosis for recovery.
I want to live as long as possible; therefore, I want to receive all medical treatment that will prolong and sustain my life
Do You Want to Donate Your Organs?
Yes - all organs for any purpose
Yes - specific organs for any purpose
Yes- specific organs for specific purposes
No
Organs to Donate
Use of Organs
Any purpose allowed by law
Transplant
Medical Research
Other (explain below)
Funeral Instructions
Do you want to be buried or cremated?
Buried
Cremated
Special Funeral Instructions
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