Estate Planning Questionnaire

Family and Personal Information

Your Full Name

Date of Birth

Your Spouses Full Name

Date of Birth

Address

Street Address Address Line 2 City State ZIP Code

Phone

Name(s) Children

Date of Birth

General Outline of Will

Specific Bequests (gifts):

Name

Address

Relationship

Gift

Primary Beneficiary (person(s) who will receive your estate; usually your spouse)

Name

Relationship

Bequest

Secondary Beneficiary (person(s) who will receive your estate after your primary beneficiary)

Name

Relationship

Bequest

Executor of Will (person responsible to carry out the terms of the will)

Name

Address

Relationship

Alternate Executor

Name

Address

Relationship

Guardian of Minor Children

Name

Address

Relationship

Alternate Guardian

Name

Address

Relationship

Trustee for Trust for minor children

Name

Address

Relationship

Alternate Trustee for Trust for minor children

Name

Address

Relationship

Agent for General Durable Power of Attorney (person who will have/be named your/spouse’s agent/attorney)

Name

Advance Medial Direct and Power of Attorney (person who will make decisions regarding your medical care)

Name

Alternate for Advance Medial Direct and Power of Attorney

Name

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757.745.7711

Estate Planning Questionnaire