Privacy Act Statement. Privacy Act-1974 as Amended my apply. This communication may contain personal information which must be protected IAW DOD 5400.11R and is For Official Use Only. Release of personal information without the member’s consent is prohibited.
WILL QUESTIONNAIRE
WILL INTERVIEW (BLDG 708): CALL (478) 926-9276, DSN 468-9276 TO SCHEDULE AN APPOINTMENT
PLEASE PRINT LEGIBLY YOUR INFORMATION 1. Your Name: ________________________________________ Your Social Security #: ________________ Sponsor’s / Retiree’s Name: _____________________ Sponsor’s / Retiree’s Social Security #: _______________________ 2. Your Status: □ Active Duty □ Retiree □ Reserve on orders/Guard with Title 10 Status □Spouse of Retiree □ Dependant
3. Your Unit:
_____________________
4. Your Contact Info: Street Address: ________________________________________ Apt/Unit/Etc: _____ City: _____________________________ State: ____ ZIP: _______ County: _______ Home/Cell: __________________ Work: ________________ 5. What state would your will most likely be probated in if you were to die today? _____
6. Spouse’s Name: _______________________ Spouse’s Phone #: __________ Spouse a U.S. Citizen? Y / N 7. Have you been married before? Y / N 8a. Child 1 Name: _______________________________ Age: _______ Is this child a stepchild? Y / N Is this child adopted? Y / N Does this child have any special needs? Y / N Name of other parent: ______________________________ If this child is under 18, who do you want to appoint as their guardian if the other parent is deceased? ______________________________________________________ Relationship _________________ Optional – (check one) □ co-guardian OR □ alternate guardian: ________________________________ Optional – guardian of the child’s property: ___________________________________ 8b. Child 2 Name: _______________________________ Age: _______ Is this child a stepchild? Y / N Is this child adopted? Y / N Does this child have any special needs? Y / N Name of other parent: ______________________________ If this child is under 18, who do you want to appoint as their guardian if the other parent is deceased? ______________________________________________________ Relationship _________________ Optional – (check one) □ co-guardian OR □ alternate guardian: ________________________________ Optional – guardian of the child’s property: ___________________________________
8c. Child 3 Name: _______________________________ Age: _______ Is this child a stepchild? Y / N Is this child adopted? Y / N Does this child have any special needs? Y / N Name of other parent: ______________________________ If this child is under 18, who do you want to appoint as their guardian if the other parent is deceased? ______________________________________________________ Relationship _________________ Optional – (check one) □ co-guardian OR □ alternate guardian: ________________________________ Optional – guardian of the child’s property: ___________________________________ 8d. Child 4 Name: _______________________________ Age: _______ Is this child a stepchild? Y / N Is this child adopted? Y / N Does this child have any special needs? Y / N Name of other parent: ______________________________ If this child is under 18, who do you want to appoint as their guardian if the other parent is deceased? ______________________________________________________ Relationship _________________ Optional – (check one) □ co-guardian OR □ alternate guardian: ________________________________ Optional – guardian of the child’s property: ___________________________________ 9. Approximate total value of all real estate (minus mortgage debt), money in bank accounts, money invested, life insurance policies, automobiles (minus note debt), expected inheritances, and other personal property items owned by you and/or your spouse: $ _________ HOW TO DIVIDE YOUR PROPERTY 10. Name a person and an alternate person to carry out your will when you die (Executor): Primary: __________________________________ Relationship: ___________ Alternate: _________________________________ Relationship: ___________ 11. Name anyone whom you would like to disinherit: ______________________________________________ 12. List specific items, real properties, or amounts of money that you would like to give to a specific person? Item/Property/Cash Amount: _________________________ Beneficiary: _______________________ Item/Property/Cash Amount: _________________________ Beneficiary: _______________________ Item/Property/Cash Amount: _________________________ Beneficiary: _______________________ Item/Property/Cash Amount: _________________________ Beneficiary: _______________________ 13. Except for the items above, you want your spouse to receive: (check one) □ Everything I own, outright □ Nothing - disinherit my spouse (note: the law limits your ability to disinherit a spouse completely) □ The following things ONLY, with everything else to be given to the people I identify in question 14: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ □ N/A – I’m not married
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14. Who do you want to receive your property if you are unmarried, if your spouse dies before you, if you have disinherited your spouse, or if you have designated in question 13 above that certain property is not to pass to your spouse? □ Any children I have, equally □ The following people (children or otherwise), are to receive the following: Portion, Percentage, Item(s), or Amount: ____________________________ Person: ___________________ Alternate Person: _______________________ Portion, Percentage, Item(s), or Amount: ____________________________ Person: ___________________ Alternate Person: _______________________ Portion, Percentage, Item(s), or Amount: ____________________________ Person: ___________________ Alternate Person: _______________________ Portion, Percentage, Item(s), or Amount: ____________________________ Person: ___________________ Alternate Person: _______________________ 15. Do you want to treat stepchildren like natural children? Y / N 16. If your child dies before you but leaves behind grandchildren, do you want those grandchildren to receive the share that their mother or father would have received (this is called “per stirpes” distribution)? Y / N 17. How old do you want your child(ren) to be before they can receive items from your will outright: (check one) □ 18 □ 21 □ 25 □ 30 If you chose ages 25 or 30, then you are automatically creating a trust: Do you want to distribute any interest your trust earns to your child when they turn 21 in order to avoid paying more taxes? Y / N 18. If at least one of your children is younger than the age you chose above: (check one) □ I want my executor to decide whether to pay the inheritance out to my child, my child’s guardian, to a property custodian, or to hold the inheritance for my child until the child reaches the age selected above. □ I want my will to create one trust for EACH child, and the trustee of each trust should hold the inheritance for that child until he or she reaches the age I selected above. □ I want my will to create one trust that will contain the inheritances of ALL of my children who are under the age I selected above. The trust shall hold the property until the youngest child turns ______. If you chose to create a trust above, who do you appoint to be the Trustee? Trustee’s Name: ______________________________ Alternate Trustee’s Name: ______________________________ Child(ren) who is(are) receiving the trust: _________________________________ If you chose to create more than one trust above, who do you appoint to be the Trustee of the second trust? Trustee’s Name: ______________________________ Alternate Trustee’s Name: ______________________________ Child(ren) who is(are) receiving the trust: __________________________________
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19. Do you have any desires regarding funeral arrangements? (cremation, military honors, etc) ________________________________________________________________________________________ 20. Would you prefer to die at home? Y / N 21. Would you like a living will? Y / N 22. Would you like to appoint a person to make medical decisions for you if you are unable to make them for yourself? This would include the authority to make decisions that might cause you to die. Y / N Person’s Name: ___________________________________________ Relationship: ________________ Person’s Street Address: ____________________________________________________________ City: _________________________ State: ____ ZIP: _______________ Person’s Telephone #: _________________________ May this person donate your organs for transplants? Y / N For research/education? Y / N Would you like to appoint a second person to make medical decisions for you? Y / N Name: ___________________________________________ Relationship: _________________ Street Address: _____________________________________________________________ City: _________________________ State: ____ ZIP: __________________ Telephone #: ________________________ Should the second agent be a co-agent with the first agent (both have to agree)? Y / N Should the second agent be able to act only if the first agent is unable to act? Y / N 23. Would you like to appoint a person to handle your financial affairs? Y / N Person’s Name: __________________________ Relationship: ________________ Street Address: ________________________________________ City: _________________________ State: ____ ZIP: _____________ Person’s Telephone #: _________________________ Would you like to appoint a second person to make financial decisions for you? Y / N Name: ___________________________________________ Relationship: _________________ Street Address: ________________________________________________________________ City: __________________________ State: ____ ZIP: _________________ Telephone #: ________________________ Should the second agent be a co-agent with the first agent (both have to agree)? Y / N Should the second agent be able to act only if the first agent is unable to act? Y / N Do you want this agent to have the power to act now, or only if you should become unable to act yourself? (check one) □ Now □ Only if I am unable to act OFFICE USE ONLY Drafting Attorney: Documents Provided: □ Will □ Living Will □ Medical Advance Directive □ General Power of Attorney □ Agent for Disposition of Remains ___________________________________ Notes:
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