WILL QUESTIONNAIRE

 

1.                   PERSONAL AND FAMILY DATE

 

Name_________________________________________________  Social Security #______________________

 

Spouse________________________________________________  Social Security #______________________

 

Address_____________________________________________________   E-Mail________________________

 

Work Phone______________________   Home Phone_____________________  Cell Phone________________

 

If either Husband or Wife has been married before, please furnish below the following information:

 

Name of Former Spouse_______________________________________________________________________

 

Date & Cause of Termination of Marriage (death, divorce, etc) ________________________________________

 

Children (please indicate if adopted or by a former marriage):

 

                          NAME                                                       AGE                            PLACE OF RESIDENCE

 

______________________________________                ___________                _________________________________

 

______________________________________                ___________                _________________________________

 

______________________________________                ___________                _________________________________

 

______________________________________                ___________                _________________________________

 

______________________________________                ___________                _________________________________

 

 

2.                   FINANCIAL DATA

 

                                                ASSET                                                                                                                                   VALUE

 

                Life Insurance Policies                                                                                                                                  ____________

 

                Savings (average balance)                                                                                                                                 ____________

 

                Securities (stocks, bonds, etc.)                                                                                                                        ____________

 

                Household goods                                                                                                                                                              ____________

 

                Vehicles                                                                                                                                                                 ____________

 

                Residence                                                                                                                                                            ____________

 

                Other Real Property                                                                                                                                        ____________

 

                Other Assets: ____________________________________________________________                             ____________

 

                _______________________________________________________________________                  ____________

 

                _______________________________________________________________________                  ____________

 

               

 

3.                   DISPOSITION OF PROPERTY

 

                1.  If you are married, do you want to leave your entire estate to your spouse?    ______________________

 

                                a.  If not, to whom do you want to leave your estate?  ____________________________________

 

                                     _____________________________________________________________________________

 

                                b. If you do want to leave your estate to your spouse, who do you want to leave it to if you spouse does                              not survive you?

 

                                   ______________________________________________________________________________

 

                                   ______________________________________________________________________________

 

                                   ______________________________________________________________________________

 

2.        Do you want to make any specific bequests or include any special terms in your Will? _______________

 

       ____________________________________________________________________________________

 

       ____________________________________________________________________________________

 

       ____________________________________________________________________________________

 

 

Attorney’s Notes:    Per Capita  __________     Per Stirpes ____________

 

___________________________________________________________________________________________________

 

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4.                SELECTION OF REPRESENTATIVES

 

                                                           Husband’s Will                                                                                    Wife’s Will

 

                Executor                 (You must name at least one person to manage your estate upon your death.  In the event that the                                       named person cannot fulfill his or duties as Executor, you should name at least one Alternate and                                        preferably two.)

 

                Name                      ___________________________________                         __________________________________

 

                Address:                 ___________________________________                         __________________________________

 

                Relationship:                ___________________________________                         __________________________________

 

                1st Alternate                ___________________________________                         __________________________________

 

                Address:                 ___________________________________                         __________________________________

 

                Relationship:                ___________________________________                         __________________________________

 

                2nd Alternate                ___________________________________                         __________________________________

 

                Address:                 ___________________________________                         __________________________________

 

                Relationship:                ___________________________________                         __________________________________

 

Guardian (In the event there are minor children and neither Husband nor Wife survive, you must name a Guardian to care for your minor children)

 

Name                      ______________________________                Alternate  ________________________________

 

                Address:                 ______________________________                Address: _________________________________

 

                Relationship:                ______________________________                Relationship: ______________________________

 

                Trustee (In the event there are minor children and neither Husband nor Wife survive, you must name a Trustee to                 manage the estate for the minor children.  You may name the same person you named as Guardian, or you may         name a different person.)

 

Name                      ______________________________                Alternate  ________________________________

 

                Address:                 ______________________________                Address: _________________________________

 

                Relationship:                ______________________________                Relationship: ______________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.               POWER OF ATTORNEY

 

                A power of attorney is an instrument by which one person (the principal) grants to another (the agent) the power to perform certain acts on his or her behalf. Two types of powers of attorney are common in the estate planning field, namely the power of attorney for health care and the durable power of attorney.

 

                The Texas Probate Code provides a means for an individual to designate another person to handle his/her affairs. The Durable Power of Attorney may take effect immediately or only upon disability. It can be drafted to provide narrow or extensive powers in the agent. It can provide for a definite termination or be perpetual until specifically revoked by the maker. A properly drafted and executed Durable Power of Attorney is inexpensive and should avoid the necessity for a costly court managed guardianship.

 

                If you do not have a Durable Power of Attorney and/or a Power of Attorney for Health Care and wish to have us prepare these for you, please answer the following questions:

 

                Name of the Person you wish to appoint:                 _____________________________________________________

                                Address:                                                               _____________________________________________________

                                Telephone Number:                            ________________________

                                Social Security Number:                 ________________________

 

                1st Alternate, if any:                                  _____________________________________________________

                                Address:                                                               _____________________________________________________

                                Telephone Number:                            ________________________

                                Social Security Number:                 ________________________

                2nd Alternate, if any:                                  _____________________________________________________

                                Address:                                                               _____________________________________________________

                                Telephone Number:                            ________________________

                                Social Security Number:                 ________________________

 

 

                Do you want the Power of Attorney to:

                                _______ Be effective upon your disability     OR     _________  Be effective Immediately

 

                What type of Power of Attorney would you like?

 

                                ________ Durable                            _________ POA for Health Care                     __________   Both