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    Estate Planning Questionnaire (2022)

    Uploaded by

    Rick
    Estate Planning Questionnaire

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Estate Planning Questionnaire (2022)

    Uploaded by

    Rick
    1 views3 pages
    Estate Planning Questionnaire

    Original Title

    Estate Planning Questionnaire [2022]

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Estate Planning Questionnaire

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views3 pages

    Estate Planning Questionnaire (2022)

    Uploaded by

    Rick
    Estate Planning Questionnaire

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Estate Planning Questionnaire

    Full Legal Name: ___________________________________________________


    Prefered Name: ________________ Previous Name: __________________
    Date of Birth: ________________ Phone #: _________________________
    E-mail Address: _______________________________________________
    Address:_____________________________________________________

    Married: (Wedding Date_______________) Divorced Seperated Single

    Spouse’s Legal Name: _____________________________________________


    Prefered Name: ________________ Previous Name: ________________
    Date of Birth: ________________ Phone #: _______________________
    E-mail Address: _____________________________________________
    Children: Yes No

    Name:___________________________________ DOB:_________________
    Relation to You: Son Daughter Stepson Stepdaughter
    Married? Yes No Children? Yes No

    Name:___________________________________ DOB:_________________

    Relation to You: Son Daughter Stepson Stepdaughter


    Married? Yes No Children? Yes No

    Name:___________________________________ DOB:_________________
    Relation to You: Son Daughter Stepson Stepdaughter
    Married? Yes No Children? Yes No

    Any Deceased Children? Yes (Name: ________________________) No

    In general terms, how do you want your estate to be distributed: ________________________


    ____________________________________________________________________________
    ____________________________________________________________________________
    I. Who will Settle Your Estate?

    Personal Representive/Executor:_________________________ Relation: ________________


    Address: _______________________________________ Phone: ______________________

    Alternate PR/Executor:________________________________ Relation: ________________


    Address: _______________________________________ Phone: ______________________

    II. Who will Settle Spouse’s Estate?

    Personal Representive/Executor:_________________________ Relation: ________________


    Address: _______________________________________ Phone: ______________________

    Alternate PR/Executor:________________________________ Relation: ________________


    Address: _______________________________________ Phone: ______________________

    III. Who Will Be Guardian for Minor Children?


    Guardian:______________________________________ Relation: _____________________
    Address: _______________________________________ Phone: ______________________

    Alternate Guardian:________________________________ Relation: ___________________


    Address: _______________________________________ Phone: ______________________
    i. Upon passing, do you want to hold your property/assets in trust for Minor
    Children? Yes (Trustee: _______________________) No

    IV. If incapacitated, who will make your financial decisions?


    Power of Attorney:___________________________________ Relation: ________________
    Address: _______________________________________ Phone: ______________________

    Alternate POA:________________________________ Relation: ___________________


    Address: _______________________________________ Phone: ______________________

    V. If incapacitated, who will make your spouse’s financial decisions?


    Power of Attorney:___________________________________ Relation: ________________
    Address: _______________________________________ Phone: ______________________

    Alternate POA:________________________________ Relation: ___________________


    Address: _______________________________________ Phone: ______________________

    2
    VI. If incapacitated, who will make your healthcare decisions?
    Power of Attorney:___________________________________ Relation: ________________
    Address: _______________________________________ Phone: ______________________

    Alternate POA:________________________________ Relation: ___________________


    Address: _______________________________________ Phone: ______________________

    i. Do you wish to be an organ donor? Yes No

    ii. In the event that you are in a permaneant state of unconsciousness and on life
    support which of the following directives do you wish you Healthcare Power of
    Attorney follow:
    Grant discrestion to Healthcare Power of Attorney whether or not to continue
    life sustaining treatment.
    Withhold or withdraw life sustaining treatment.
    Continue with the maximum life sustaining treatment.

    VII. If incapacitated, who will make your spouse’s healthcare decisions?


    Power of Attorney:___________________________________ Relation: ________________
    Address: _______________________________________ Phone: ______________________

    Alternate POA:________________________________ Relation: ___________________


    Address: _______________________________________ Phone: ______________________

    i. Does your spouse wish to be an organ donor? Yes No

    ii. In the event that your spouse is in a permanent state of unconsciousness and on
    life support which of the following directives do you wish you Healthcare Power
    of Attorney follow:
    Grant discrestion to Healthcare Power of Attorney whether or not to continue
    life sustaining treatment.
    Withhold or withdraw life sustaining treatment.
    Continue with the maximum life sustaining treatment.

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