Estate Planning Worksheet Testator Information First name, Middle, Last: Phone Number: (daytime) (evening) Address City, State, zip County Mailing Address:
Marital Status: (check one) Spouse’s first, middle, last name
Single
Married
Divorced
Widowed
I want my entire estate transferred to my spouse if I should die first. Children’s Info First 1. 2. 3. 4. 5. 6. Middle current city, state, County of residence
Yes
No
under 18?
Deceased?
If you have minor children, who is to be the primary and alternate caretakers? Name Current City/state/county 1. 2. Do you have arrangements for burial or cremation of your body Relationship to you
If so, what arrangements? Do you have any final instructions regarding your burial or cremation? Who is the primary personal representative (executor) of you estate? Name current city/state/county Alternate ? Would you like them to compensated for their time? If so, in what manner? An additional percentage? Flat fee? Relationship
Assets Any real estate that will need to be transferred? To whom will it be transferred? If to more than one, in what percentage each? Is there any titled property such as vehicles and the like to be transferred? Item description and who will receive it Are there any stocks, bonds, mutual funds, retirement funds or life insurance policies to be divided between your beneficiaries? If so, please list in detail: Type of account /Financial Institute/ percentage to beneficiary Residuary How would you like the remainder of your estate distributed? Name / relationship to you? Charities? Any additional provisions? Additional Documents Please check any additional documents you would like us to create for you Healthcare Directive (living will)
Durable Power of Attorney Community Property Agreement (CPA) Healthcare Directive Questions Do you wish to have your life artificially extended if using these would only serve to prolong death? Please select the methods of artificially prolonging your life that you want WITHHELD Nutrition Hydration Medication Do you authorize an autopsy? Are you an organ donor? Power of Attorney Who do wish to make decisions for you if you are unable to make them for yourself? Name/ relationship to you/ contact information Is there an alternative in any your primary choice is unable or unwilling to assume this role? Name / relationship/ contact info Would you like this directive to be in affect immediately or only upon you becoming incapacitated?