Name * Email Address * Address * Date of Birth If Married: Spouse's Name Spouse's Date of Birth Children: Please list all children, including those born out of wedlock, in a prior marriage and/or legally adopted. Please provide Names (first, middle, last) and dates of birth. Do you currently have a will? Personal Representatives (Executor): The personal representative is the person who pays your debts and distributes your property to your heirs after you die. If married, your spouse will be nominated automatically unless otherwise indicated. Please provide full name, address, and relationship of the nominated person. First Choice Personal Representative: Second Choice Personal Representative: Who would you want to act as a guardian/custodian of any minor children if you and your spouse pass away? Second choice guardian/custodian of any minor children? Trustee (minor/disabled children/estate taxes): If you decide to put your estate in a trust for children, or if a trust is needed for tax purposes, who would you want to be in charge of those assets? Please provide full name, address, and relationship of the nominated person. First Choice Trustee: Second Choice Trustee: Who would you like to designate as your Attorney-In-Fact for your Durable Power of Attorney (Attorney-In-Fact name and address)? First Choice: Attorney-In-Fact Second Choice: Who would you like to designate as your health care agent to make health care decisions for you and act on your behalf if you are unable to decide or speak for yourself (agent's name, address, phone number, and relationship to you)? First Choice: Health Care Agent Second Choice: Approximate Gross Annual Household Income? Who would you like to receive your assets when you die? Please list names and relationship to you in order of priority (e.g., Spouse 1st Choice, Children 2nd Choice...): To draft your Will or Trust, we need to know what property you own. Below, please provide us with information regarding any real estate that you own, including the estimated value of the property, amount owed on a mortgage (if any), the property address, and how the property is titled: Please provide us with details regarding your life insurance, including type of life insurance (Group, Whole Life, Term), the individual who is insured, the benefit amount, and the exact way the beneficiaries are listed on the policy: Please provide us with details regarding your financial accounts, including bank accounts, retirement accounts (IRAs, 401k, pension plan, annuities) and other investments (stocks, bonds, mutual funds). Please be sure to include the type of account, the account holder's name, the approximate balances, and the exact way the beneficiaries are listed: Do you have any specific charitable institutions you may be interested in contributing to? Do you wish to donate your organs? Do you wish to donate your remains to science? Do you want to be cremated? Do you request a post mortem autopsy?