Step 1 of 19
Name:
Spouse's Name:
Home Address:
Mailing Address: (if different)
Home Telephone:
Work Telephone:
Your Date of Birth (mm/dd/yy):
Spouse's Date of Birth (mm/dd/yy):
Marriage Place:
Marriage Date (mm/dd/yy):
Citizenship:
Step 2 of 19
♠ Please Note: If you have been previously married more than once, please provide all requested information for any additional spouses on a separate sheet.

Name of Former Spouse:
Date of Marriage (mm/dd/yy):
Specify if the marriages terminated by death or divorce:
Date of Termination of Marriage (mm/dd/yy):
List any relevant information regarding any obligations, child support, or maintenance that is not contained in any dissolution decrees you have attached to this form:
Step 3 of 19
♠ Please Note: Please list any adopted children under the applicable categories and indicate that they are adopted. Also, please indicate if any children are deceased.

List all children from your current marriage, providing their names, dates of birth, and addresses if different from your own:
List all children from any previous marriage or relationships, providing their names, names of the other parent, dates of birth, and addresses if different from your own:
List all children of your spouse from any previous marriage or relationship, providing their names, names of the other parent, dates of birth, and addresses if different from your own:
Step 4 of 19
♠ Remember: If you cannot, or do not wish to, answer any questions in full at this time, keep on going. You'll have the chance to fill in the blanks later.

Are there any persons, other than minor children, who are partially or wholly dependent upon either you or your spouse for support now or possibly in the future? If so, please list their name and address and describe the nature of the relationship.
Step 5 of 19
List the names, dates of birth, parentage, and current addresses of any grandchildren of you or your spouse:
List the names, addresses, and birth dates of your parents, if still living:
List the names, addresses, and birth date of any living siblings:
Step 6 of 19
Do you currently receive income from a trust?
If so, please attach a copy of the trust document.
Does any family member expect to be named a beneficiary or remainderman to a trust? If so, please describe:
Step 7 of 19
Are there any life insurance policies in existence for either spouse?
If so, please indicate the name of the policy holder and provide information regarding:
Name of Company(ies):
Type of Insurance:
Amount and Cash Surrender Value:
Designated Beneficiary(ies):
Step 8 of 19
Do you own any real or personal property as joint tenants with your spouse or third parties? If so, please explain:
Step 9 of 19
Are you enrolled in a retirement plan?
If so, please provide information regarding the type of plan, current value, and beneficiary designation:
Step 10 of 19
Are either you or your spouse likely to receive any gifts or inheritances? If so, please describe:
Do either you or your spouse make, or intend to make, regular gifts to any person? If so, please describe:
Step 11 of 19
♠ Please Note: There will be a section at the end to write in any addtional assets or liabilities.

AssetsApproximate Value
Real Property:
Stocks and Bonds:
Checking/Savings/Other Monetary Accounts:
Cash Value of Life Insurance Policy:
Retirement Benefits:
Miscellaneous Property (including furniture, anitques, automobiles, boats, collections, etc.):
LiabilitiesApproximate Value
Mortgage or deed of trust or other amounts owed on real property:
Other loans from financial institutions (consolidated loan, home equity loan, etc.):
Student loan:
Amounts owed on credit cards:
Other liabilities:
Step 12 of 19

Please attach a copy of the deed for each parcel of real property that you own.
Step 13 of 19
Personal Representative
A personal representative administers your estate in accordance with the instructions contained in your Will. Please list a first choice and an alternate, in case the person who is your first choice predeceases you or is unable to serve:
First Choice
Name:
Address:
Relationship:
Alternate
Name:
Address:
Relationship:
Distribution
Please list the individuals to whom you wish to leave your estate providing instruction as to what percentage shall be received by each beneficiary:
If any of your designated beneficiares should predecease you, do you want to distribute the gift among surviving beneficiaries? Or pass the gift to the children of deceased beneficiary?
Guardianship
If you die before your children reach the age of eighteen, who do you wish to serve as their guardian?
First Choice
Name:
Address:
Relationship:
Alternate
Name:
Address:
Relationship:

Charitable Interests
Please list those charitable organizations, include your church and/or synagogue, that you would like to bequeath an interest from your estate, and the approximate amounts(s) you would like to leave to each:
Testamentary Trust
If you wish, you can create a testamentary trust in your Will to become effective upon your death. The classic reason to establish such a trust is to ensure the well-being of your minor children, finance their education, etc. However, a testamentary trust can be created to accomplish a wide variety of goals. If you are interested in creating a testamentary trust, or have questions, please indicate your wishes and questions below.
Step 14 of 19

The Durable Power of Attorney becomes effective upon the proven incompetency of an individual to handle his or her own affairs. In this document, you would name a person who would take charge of your affairs (known as your "attorney-in-fact"). The value of this document is that it eliminates the need to establish a guardianship in the event of incompetency.

Do you need this document prepared?
Who do you wish to nominate as your attorney-in-fact?
Name:
Address:
Relationship:
Alternate
Name:
Address:
Relationship:

Do you have questions? If so, please list:
Step 15 of 19
♠ Please Note: Your attorney-in-fact should be a person in whose judgment you trust.

The Power of Attorney for Health Care authorizes the designated attorney-in-fact to authorize or withhold medical care if you are unable to do so yourself. The person so designated should be a person with whom you have discussed issues such as use of medical means to prolong your life artificially.

Do you need this document prepared?
Who do you wish to nominate as your attorney-in-fact?
Name:
Address:
Relationship:
Alternate
Name:
Address:
Relationship:

Do you have questions? If so, please list:
Step 16 of 19

The Directive to Physicians clarifies a person's wish not to have his or her life "artificially prolonged" in the case of any injury, disease or terminal condition rendering such person unable to communicate.

Do you need this document prepared?
Do you have questions? If so, please list:
Step 17 of 19
Please indicate whether you are interested in having a trust to make sure that your pet is taken care of in the event of your death.
Step 18 of 19
Is there any other information that you think may be important in planning your estate that I have not addressed? Please specify:
Step 19 of 19

Please list your current professional legal and financial advisors here:

Attorney:
Name:
Address:
Phone:
Accountant:
Name:
Address:
Phone:
Stock Broker:
Name:
Address:
Phone:
Insurance Agent:
Name:
Address:
Phone: