Estate Planning Questionnaire Fill out the online form or download/print the PDF Start Online Form Prefer to download & print the PDF? If you'd rather input your information directly on a PDF document and bring to our office, please download the questionnaire applicable to your situation. Estates with Children Estates without Children Online Questionnaire Securely submit your questionnaire information to get your estate planning started 1Personal Info2General Power of Attorney3Healthcare Power of Attorney4Will Information (with Children)5Will Information (with Children over 18)6Will Information (Other Beneficiaries)7Will Information X/TwitterThis field is for validation purposes and should be left unchanged.Personal InformationPlease state full names exactly as you want them to appear in your will and other estate planning documents. Where the space on the form is insufficient, please use the reverse side.Full Name(Required) First Middle Last Date of Birth(Required) Month Day Year Spouse's Full Name(Required) First Middle Last Spouse's Date of Birth(Required) Month Day Year Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone Number(Required)Email(Required) Preferred Method of Contact(Required) Phone Text Email Do you have children?(Required) Yes No General Durable Power of Attorney InformationThe General Durable Power of Attorney is a document that grants people whom you trust authority to act on your behalf. Agents are people you appoint through this document who maintain the power to make decisions on your behalf when you are not present. Agent 1 will have sole power unless he/she is unable to do so; then, the power is given solely to Agent 2, and so on. The General Durable Power of Attorney clearly outlines those people and the circumstances in question. This document is only used when you are alive. You may, but do not have to, list multiple Agents.Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Do you wish to add another agent? Yes No Healthcare Power of Attorney InformationYour Healthcare Power of Attorney, along with Advanced Directives is a document that allows a trusted person to act on your behalf for healthcare decisions, only if that need should arise. You also advise doctors and your agent(s) on your wishes regarding end-of-life care with this document. Healthcare Agents are people you appoint who maintain the power to make decisions regarding your health if you are unable to do so. The Healthcare Power of Attorney clearly outlines these people, the circumstances in question, and your wishes. These people can be, but do not have to be, the same as the Agents in The General Power of Attorney. You may, but do not have to, list multiple Agents.Name First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Will Information (with Children)Your Will is the document that clearly outlines your assets and how you wish to distribute them, as well as who will receive them. In your Will, you will appoint various people who have varying roles. Your Executor maintains the power to oversee and execute the provisions contained in your will. Their responsibility is to ensure your assets are distributed as specified in your will, as well as pay any debts, taxes court costs and the like. A Guardian is a person(s) whom you appoint to act in the best interest of minor children should you pass before they are 18. List any children under 18 as well as their date of birth. If you have children 18 or older, please see “Will Information -Children 18 or Older Only-”.Children Under 18(Required)Child #Full NameDate of Birth Add RemoveGuardians(Required)Full NameDate of BirthPhone Add Remove Will Information (Children 18 and Older)Your will is the document that clearly outlines your assets and how you wish to distribute them, as well as who will receive them. In your will, you will appoint various people who will have different roles. An executor is the person you choose who maintains the power to oversee and execute your will. This person will make sure everything is done exactly how you have specified in your will. List any children 18 and older as well as their address, phone number, and date of birth. If you have children under 18, please see “Will Information -Children Under 18 Only-”.Children Over 18(Required)Child #NameDate of BirthPhoneFull Address/City/State/Zip Add Remove Will Information: Other BeneficiariesList any beneficiaries you would like to include, as well as their address and phone number.Other Beneficiaries(Required)Full NameDate of BirthPhoneFull Address/City/State/Zip Add Remove Will InformationYour Will is the document that clearly outlines your assets and how you wish to distribute them, as well as who will receive them. In your Will, you will appoint various people who have varying roles. Your Executor maintains the power to oversee and execute the provisions contained in your will. Their responsibility is to ensure your assets are distributed as specified in your will, as well as pay any debts, taxes court costs and the like. List any beneficiaries you would like to include, as well as their address and phone number.Beneficiaries(Required)Full NameDate of BirthPhoneFull Address/City/State/Zip Add Remove
