Will Questionaire
For use as attorney-client work product only.
Today's Date:
Full Name to Appear on Will:
Address:
Telephone Number:
County:
Gwinnett OR:
Disposition of Remains:
Burial
Cremation
Any specific bequests or devises (including charitable bequests):
No
Yes, As follows:
Item
Beneficiary
Spouse's Full Name:
Upon my death, all (remaining)property to my spouse if living:
Yes
No, As follows:
If my spouse dies first, all (remaining) property to my children,
PER STIRPES
:
Yes
No, As follows:
Names of Children from this Marriage
Dates of Birth
Include provision for future born or adopted children:
Yes
No
Do you have children from another marriage?
No
Yes, As follows:
Names of Children
Dates of Birth
Does your spouse have children from another marriage?
No
Yes, As follows:
Names of Children
Dates of Birth
If my spouse and my children predecease me, then all (remaining) property 1/2 to my heirs-at-law and 1/2 to my spouse's heir-at-law:
Yes
No, As follows:
Executor/Executrix:
My Spouse OR:
Sucessor Executor/Executrix:
Do you want your will to establish a trust for children (because of their young age or disability)?
Yes, as follows:
No
Trustee(s) for my children under age 21:(not your spouse)
Successor Trustee(s):
Distribute trust property to children at age 21:
Yes
No, As follows:
Guardian(s) for my children under age 21:(not your spouse)
Same as trustee(s) OR:
Successor Guardian(s):
Same as succesor trustee(s) OR:
Simultaneous Death - Presumption that husband died first:
Yes
No, As follows:
Prepare mirror image will for spouse:
Yes
No - See separate will questionaire
Prepare living will:
Yes
No
Prepare durable power of attorney (for health care):
Yes
No
Guardian/Agent for health care decisions:
My Spouse OR:
Name:
Address:
Successor Guardian/Agent for health care decisions:
Name:
Address:
Prepare general power of attorney and designation of guardian:
Yes
No
Guardian/Agent:
My Spouse OR:
Name:
Address:
Successor Guardian/Agent:
Name:
Address:
Name of my regular physician:
Asset and Debt Information
Assets
Value
Husband's Name
Wife's Name
Joint Names
Cash
Saving Accounts
Partnership, Sole Proprietor or Other Business Interests
CD'S/Money Market Accounts
Real Estate: Home
Other
Automobiles
Money Owed You
Retirement/IRA
Furniture/
Furnishings
Jewelry
Life Insurance (Cash Value)
Collectibles
Bank Accounts
Other Assets
Total Assets
DEBTS
Balance
Home Mortgage
Second Mortgage
Automobile(s)
Other Loans
Credit Card Debt
Tax Liabilities
Other Debts
Total Debts
