LAST WILL AND TESTAMENT
QUESTIONNAIRE
Privacy Act Notice:
AUTHORITY: 10 U.S.C. § 8012, EO 9397; PRINCIPAL PURPOSE: To collect data on
you to assist your lawyer in drafting your will. It will not be disseminated
outside the legal office and is considered confidential. ROUTINE USES: See
principal purpose; DISCLOSURE IS VOLUNTARY: You are not required to complete
this form; however, your failure to do so may mean the legal office cannot
provide you with a will.
Date
of appointment with attorney:_________________________
Personal Data:
1. Full Name:_____________________________________________________________Male____/Female____
First Middle
Name Last
Address:_____________________________________________________________________________________
Are you a U.S. Citizen?
___Yes ___No
Do your assets, including Life
Insurance, total more than $500,000? ___Y___N
Do your assets, including Life
Insurance, total more than $1,000,000? ___Y___N
Note:
If your assets, including life insurance policies, now exceed or are soon
expected to exceed $1,000,000, you may advised to discuss your estate-planning
options with a civilian attorney who specializes in that field.
2. State
of Legal Residence: ________________________ . This is
the state listed on your leave and earning statement (LES).
3. Military Status: ____Active/____Retiree/____Dependent/____Guard/Reserve
4. Marital
Status: ___single/___married/___divorced/___pending divorce/___divorced
& remarried/___widow(er)
If married, spouse’s full
name: ________________________________ Is spouse a U.S. Citizen? ___Yes
___No
Were you previously married?
______Yes ______No
5. Children: Do
you have children? __Y__N If yes, use the following codes to indicate status
of children: N=natural;
S=stepchild;
A=adopted. Do you wish to treat adopted/stepchildren the same as natural
children? __Y__N
FULL NAME (Including full middle name) Sex Age Status
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Spouse and Child Beneficiaries:
6. If married, do you want
all of your real estate and personal property to go to your spouse? ____yes
____no
7. If you are not married or your
spouse does not survive you, do you want all of your real estate and personal
property to go to your children? ____yes ____no
8. If
any child is under the age of 18, at what age do you want them to receive their
share of the estate: ______
9. Do you want to give
your Executor to have control/discretion on when and how to distribute a minor
child’s inheritance? ___ Yes ___ No By answering no, you may create a Trust that can have
additional requirements and expenses.
10. If
no, who do you wish to exercise that control? _________________________
Relationship: _________________
11. If any of your children do not survive you, do
you want his or her potential share of your inheritance to pass to his or her
children (your grandchildren)? ____yes ____no
12. Do any of your children or other beneficiaries
have either a physical or mental disability? ____yes ____no
Contingent Beneficiaries:
13. If your spouse and children die before you die,
or you are unmarried or have no children, or you want your property distributed
in a way different from that described above, you may designate other or
additional beneficiaries below: IF YOU NEED MORE ROOM ATTACH AN ADDITIONAL
SHEET
FULL NAME
Relationship City & State Distribution
First Middle
Last
All or share (%)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Other Property:
14. Do you have a farm or
family-owned business? ___Y___N
15. Are you the beneficiary
of any Trust? ____ Do you hold any powers of appointment? ____ Not sure?
_____
16. Do
you own real estate that will be distributed by this will? ___Y___N
17. Do you wish to make a specific cash bequest?
___Y___N (If yes, please list:)
Name Relationship City/State
Amount
___________________________________________________________________________________________
18. Executor/Personal Representative: Whom
do you wish to serve as executor of your estate? Your Executor is the person
who will be responsible for gathering and distributing your assets and filing
your will in probate after your death. This person has administrative duties
only and must distribute your estate in accordance with your will. A
surviving spouse is not automatically appointed.
Primary:
___________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
Alternate:
__________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
19. Guardian: Do you wish to appoint a
guardian of your minor child(ren) if the other natural parent is not alive or
for any reason cannot act as guardian? __Y___N A guardian must be 18 years of
age or older. This person will have actual physical custody and control of the
minor children until they reach age 18.
Primary
Guardian:
_________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
Alternate
Guardian:
________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
20. Trusts: If you have minor children who
may receive property under your will, you can set up a trust in your will to
place the property under the control of a trustee, for the benefit of your
child(ren) until they have reached an age you designate.
Primary:
________________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
Alternate:
________________________________________________________________________________________
Full Name City/State
of Current Residence Relationship
Age when property should be distributed to each child:
_____ (At least 18 in most states)
21. Are you
interested in a Living Will or Durable Health Care Power of Attorney (ask your attorney about these)? ______
22. Are
you interested in a “springing” Durable General Power of Attorney (one which will survive incapacitation)? ______