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 □ Reserve on orders/Guard with Title 10 Status □ Dependant
□ Retiree □Spouse of Retiree
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: Notes:
□ Will
□ Living Will
□ Medical Advance Directive
□ General Power of Attorney
□ Agent for Disposition of Remains
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