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Wills, Trusts and Probate Questionnaire

I.    Client Information

Name:

Address line 1:

Address line 2:

City:

State:

Zip:

Date of birth:

Email address:

Telephone number:

II.    Marital Status / Spouse's or Past Spouse's Information

Your current marital status:

 

Spouse's Full Name:

Other names used by spouse:

Spouse's date of birth:

Date of marriage:

Place of marriage:

Marriage termination date:

Have you entered into any pre-nuptial or post-nuptial agreements?

III.    Children

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

IV.    Children By Previous Marriages

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

V.    Siblings

Name:

Relation:        

Name:

Relation:        

Name:

Relation:        

Name:

Relation:        

VI.    Legal Description of Real Estate

Please provide for us the legal description of any real property in which you have an interest:

Property 1:

Property 2:     

Property 3:

VII.    Appointment of Fiduciaries

Executor:        

Relation:     

Address:

1st Alternate Executor:    

Relation:     

Address:

2nd Alternate Executor:   

Relation:     

Address:

Guardian for any minor children:

Guardian:     

Relation:
Address:

1st Alternate Guardian:   

Relation:     

Address:

2nd Alternate Guardian:   

Relation:     

Address:

Trustee for any minor children:          

Trustee:     

Relation:
Address:

1st Alternate Trustee:   

Relation:     

Address:

2nd Alternate Trustee:   

Relation:     

Address:

VIII.    Size of Anticipated Estate

        Do you anticipate the amount of your combined estate (including, but not necessarily limited to real estate, personal property, insurance proceeds, investments, retirement accounts/funds, etc.) to be:

IX.    General Plan For Bequests

        Please describe your general desires, goals, and objectives with regards to how you would like your estate to be treated/distributed upon your death.  Please include any special concerns you may have.

X.    Other Planning Items

1)    Statutory Durable Power of Attorney

        A Statutory Durable Power of Attorney is designed to allow the designated          person or persons to manage your financial affairs should you become mentally or physically unable to do so.

Name:              

Address:     

Telephone:

2)    Health Care Power of Attorney

        A Health Care Power of Attorney allows the designated person or persons to consent to medical care on your behalf should you suffer an injury or become mentally or physically disabled.

Name:              

Address:     

Telephone:

3)    Designation of Guardian for Yourself

        A Designation of Guardian for Yourself allows the designated person to serve as your guardian should you become incapacitated.

Name:              

Address:     

Telephone:

4)    HIPAA Authorization for Release of Patient Health Information

        A HIPAA Authorization for Release of Patient Health Information is designed to allow the designated person or persons obtain copies of your medical records.

Name:              

Address:     

Telephone:

5)    Directives to Physicians

        A Directives to Physicians (also known as a "Living Will") instructs your doctor to disconnect any life support systems if you are suffering from an incurable or irreversible condition caused by injury, disease, or illness certified to be a terminal condition by two physicians.

        Are you interested in a Directives to Physicians? 


 

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Law Offices of Jason S. Coomer, PLLC
406 Sterzing, Second Floor
Austin, TX 78704
Toll Free: (512) 474-1477
Phone: (866) 474-1477
Email: info@TexasLawyers.com

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