Wills, Trusts and Probate Questionnaire
I. Client Information
Name:
Address Line 1
City:
State:
Zip:
Email address:
Telephone Number:
Best time to call:
II. Marital Status / Spouse's Information
Your Current Marital Status: [Select One] Single/Never Married Married Married but Separated Divorced Widowed
Spouse's Full Name:
Other names used by spouse:
Spouse's age:
Spouse's date of birth:
Date of marriage:
Place of marriage:
Name of current employer:
Business phone:
Occupation:
Present state of health:
Previously executed a will:
Previously established a trust:
Have you entered into any pre-nuptial or post-nuptial agreements? Yes No Date: State & County:
III. Children
Date of birth:
IV. Children By Previous Marriage
V. Grandchildren
Father:
VI. Siblings
Relation:
Are you or any member of your family a beneficiary of any trust established by others:
Are you eligible for military benefits or retirement:
VII. 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:
VIII. Appointment of Fiduciaries
Executor:
1st Alternate:
2nd Alternate:
Guardian:
Trustee:
IX. 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: [Select One] less than $1,000,000 $1,000,000 to $2,000,000 greater than $2,000,000
X. 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.
XI. 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.
Address:
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.
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.
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.
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? Yes No
