Information Sheet

Information Sheet

To proceed with having a Will or Living Trust prepared, we recommend that you complete the following questionnaire. This form includes the basic information needed to have a Will or Living Trust prepared. If you have questions regarding Wills or Living Trusts, or need assistance in completing this form, do not hesitate to call. We will gladly answer your questions.

Once the questionnaire is completed, you can submit it to us via the computer by clicking "Submit" (at the end of the questionnaire) or if you prefer, you can print it out and fax or mail the questionnaire to us. The fax number and address can be obtained from our Contact Us page.

Please call to schedule an appointment. You will need to bring (or fax) a copy of the Deed to any real estate you own IF you want a Living Trust.

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Contact Information

Note: you may tab to the next field.

Name:

* Required

Email Address:

* Required

Your Information
First Name:
Middle Initial:
Last Name:
Birthday:		mm/dd/yyyy
SSN:		(optional)
Marital Status:

Spouse / Partner Information (if any)
First Name:
Middle Initial:
Last Name:		(if different)
Birthday:		mm/dd/yyyy
SSN:		(optional)

Street Address:
City:
State:
Zip Code:
Daytime Phone Number:		+ extension
Evening Phone Number:

Do you have Children?	Yes No
Are Any Minors?	Yes No
List Children Below	Name	Age
Child # 1
Child # 2
Child # 3
Child # 4
Child # 5

Guardian for Minor Children (if applicable):
First Choice:
Second Choice:

Estate

Who do you want to manage your estate, upon your death: If married, the spouse is usually named first. If that is your desire, enter "Spouse" as first choice If single, it is only necessary to designate a first and second alternate.
First Choice ("Spouse", if married):
Second Choice / Alternate:
Third Choice / Alternate:

Upon your death, how would you want your estate distributed?
First, to spouse, if surviving
Second, to children
Other (specify):

If one of my children predeceases me (us), that child's share shall be distributed to:
My (our) other children then living:
The offspring of my (our) deceased child:

If distribution is made to minor children, what age(s) would you want them to receive their inheritance?

18 21 25 other

If you become incapacitated, who would you want to make:

Business and Financial decisions for you? (If married, and you want your spouse, enter "Spouse" as first choice.)
First Choice:
Second Choice / Alternate:
Third Choice:

Health Care Decisions for you? (If married, and you want your spouse, enter "Spouse" as first choice. If husband and wife want different alternatives to make health care decisions, specify "Wife's" and "Husband's" choices.)
First Choice:
Second Choice / Alternate:
Third Choice:

Please select all that apply:
You	Living Will*	Organ Donor	Cremation
Spouse	Living Will*	Organ Donor	Cremation
*Living Will - Adocument specifying that you do not want to be kept alive by machines if you are in a coma, etc.

What is the approximate amount of your Net Worth (including the death benefit on life insurance)?
Amount:
Do you own a business?	Yes No
If Yes, what type of business?
Please select document desired	Will Living Trust

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