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Worksheet: Information For Your Will

Print Version

PERSONAL INFORMATION

Date:

Full Name (as it appears on your drivers license, ID card or passport):


First

Middle

Last

Do you use another name or nickname on deeds, bonds, stocks, bank accounts, etc.?

What other name(s) do you use?

 

Home Address:

Street: Apt. No:

City: State: Zip Code: -

 

Occupation (current, or last if no longer working):

Employer:

Name: Address:

 

Date of Birth: Social Security No:

Telephone:
Home

Work

Mobile

 

What state do you consider to be your home?

How long have you lived in that state?

Place of birth (citizenship):

Branch and dates of Military Service:

 

RELATIVES

Name: Address:

 

Prior Marriages

Name Of Former Spouse(s):

Date Of Divorce(s):

Place Of Divorce(s):

Are there continuing financial responsibilities from this/these marriage(s)?

 

Your Children (list all):

Name

Date Of Birth/Death

Address (if not living with you)

Other Parent Name

 

Your Grandchildren (list all):

Name

Date Of Birth/Death

Address (if not living with you)

Both Parent Names

 

Your Parents:

Name

Date Of Birth/Death

Address (if not living with you)

Maiden Name

 

Your Brothers And Sisters:

Name

Date Of Birth/Death

Address (if not living with you)

Brother/Sister

  • Brother
  • Step-Brother
  • Sister
  • Step-Sister

 

PRIOR WILLS

Have you ever made a Will?

Indicate the following for the most recent will:

When was the Will made?

Was the Will revoked?

If yes, how and when?

Where is the prior Will now?

 

ADVANCE PLANNING

Do you have a Living Will, a document which states your wishes in case you become
incapacitated and cannot speak for yourself?

  • Does your primary care physician have a copy?
  • Who else has copies?

  • Do you want one?

 

Do you have a Health Care Power Of Attorney, a document which appoints another person to make decisions
about your health care if you can't?

  • Who is the person named as proxy?
  • Who is named as substitute proxy?

  • Do you want one?
 

Have you executed a Do Not Resuscitate Order, a document which orders the medical system not
to revive you if your heart or lungs stop working?

  • Who has a copy?

  • Do you want one?
 

Have you executed a General Power of Attorney, a document giving another person authority to
act over your assets?

  • Who is named as your agent?

  • Do you want one?
  • Do you want your agent to have the power to take over your financial affairs now (at the
    time you execute the document) or at the time you become incapacitated and no longer able to
    physically manage your financial affairs? Now At the time of incapacity

 

Do you have an Ethical Will, a document that passes on your family memories and values?

If no, see our article on Ethical Wills and consider writing one.

 

Do you have any directions concerning your funeral, burial, cremation, or interment, including a maximum amount of money to be spent?

What are your directions?

 

Do you own a cemetery plot?

Where is it?

Have you made prepaid funeral arrangements?

With whom?

 

Hospital Visitation: If you were hospitalized, is there anyone (who is NOT related to you by blood, legal marriage, or adoption) whom you would ALWAYS want to be allowed to visit you in hospital?

Is there anyone you would NEVER want to be allowed to visit you?

If yes to either, please write their names below and specify your desire:

 

ASSETS

Real Estate

Location

Approximate Market
Value Today

Approximate Amount
of Remaining Mortgage

Other Names On Deed

 

Bank Accounts

Bank

Checking or Savings
Account?

Listed In Your Name Or
With Others? If Others,
List All Other Names

Estimated Balance

$

 

Safe Deposit Box

Do you have a Safe Deposit Box?

Where? (Name of bank and location for each box:)

 

Securities

 

Approximate Market Value

Names of Co-Owners

Stocks (both common
and preferred)

$

Mutual Funds

$

Bonds

$

 

Business Interests

Do you have an ownership interest in any business?

List name of business, percent you own, and approximate value of your interest:

 

Business Benefits

Do you have any business benefits (such as a pension plan, IRA, profit-sharing fund, deferred compensation plan, or stock options)?

Benefit

Value Today

Beneficiary

$

 

OTHER ASSETS

 

Approximate Market Value

Name of Co-Owner

Debts owed to you

$

Car or other Vehicle

$

Boat and/or Mobile Home

$

Jewelry

$

Furnishings and Antiques

$

Anticipated Inheritance or Gift

$

Other

$

 

LIFE INSURANCE AND ANNUITIES

List all policies you own or have owned within the last three years. Include life insurance through work and other groups.

The Policy

Important Facts About The Policy

Name Of Beneficiary

Company name:

Amount of cash value, if any :

$

 

Amount of loans against policy, if any :

$

Have you assigned ownership of policy?

 

DEBTS AND LIABILITIES

 

Total Amount

Credit cards:

$

Bank loans (other than mortgage on real estate):

$

Other loans:

$

Contingent Obligations and Guarantees:

$

 

GIFT TAXES

Have you on your own made a gift in any year to any particular person in any year prior to 2006 in excess of $10,000, or since 2006 in excess of $12,000?

If you are legally married, have you and your spouse in any year made a gift to any particular person prior to 2006 in excess of $20,000 or since 2006 in excess of $24,000?

 

WHAT YOU WANT TO DO WITH YOUR ASSETS

Tangible Personal Property (personal effects, car, jewelry, art, antiques, and other objects)

Item

Beneficiary(ies)

Alternate Beneficiary(ies)

(To receive asset if beneficiary dies before you)

Comments *


Name:

Relationship to you:

Name:

Relationship to you:

 

All Other Property (savings, stocks, bonds, real estate, etc.)

Item

Beneficiary(ies)

Alternate Beneficiary(ies)

Comments *


Name:

Relationship to you:

Name:

Relationship to you:

 

Residuary Estate (property not covered above)

Portion

Beneficiary(ies)

Alternate Beneficiary(ies)

Comments *


Name:

Relationship to you:

Name:

Relationship to you:

* Include:

  • How asset is to be divided if more than one beneficiary is to be name. For example: Equally.
  • Any conditions or limitations on the receipt of the items
  • Who shall pay for packing, insurance and transportation (if costly)
If more room is needed, use the "Additional Comments" section below.

 

Who should pay inheritance taxes, if any?
Each recipient of property pays own share of taxes.
Estate pays all taxes.
Other (please describe):

If you own real estate:

  • Who shall pay expenses (e.g., taxes, utilities) of your real property (if any) while your estate is being administered?
    The estate The beneficiary

  • Do you want the real estate to pass to your beneficiary(ies) subject to all mortgages, liens and encumbrances?

Do you wish to specifically disinherit any of your family members?

If yes, please list full name and relationship of the person(s) you wish to specifically omit from your bequests:

 

PERSONAL REPRESENTATIVE/EXECUTOR

Your Personal Representative/ Executor is the person you choose to carry out the instructions in your Will. For advice on choosing a Personal Representative, see Choosing A Personal Representative.

Name:

Address:

Telephone No. Mobile No.

E mail address:

Name and address of alternate Personal Representative, if first preference should die before you or otherwise cease serving as Personal Representative:

Name:

Address:

Telephone No. Mobile No.

E mail address:

Do you wish to waive a requirement that the Personal Representative/Executor post a bond guaranteeing honest performance?

 

GUARDIAN

A Guardian is the person who will have legal custody of your children. (See Guardianship of Children.)

Do you have custody of a minor child who will require a guardian upon your death?

Whom do you want to serve as guardian?

Name:

Address:

If your first choice for guardian is NOT the child's natural parent, please list your reasons in the "Additional Comments" section why the other parent should not be appointed guardian and check here: .

Please be as specific as possible. A judge will assume that a child should be raised by his/her natural parent. It would be helpful to explain why it would not be in the best interest of your child to be raised by his/her other natural parent. Also describe why the person you suggest is better suited to care for your child.

Are any recipients of your property minors?

List their names and dates of birth:

Name

Date of Birth

How is the property to be held until the child reaches adulthood? By a person for the child? In a trust? Another way? Please explain.

 

ADDITIONAL COMMENTS

(Any additional comments or facts the lawyer should be aware of)

 

DOCUMENTS TO TAKE TO THE LAWYER

Take with you to the lawyer a copy of this Worksheet and any of the following documents you have which are readily available. Even if you don't take them, please check the documents that apply to you:

Your most recent Will and any Codicils (amendments)
Copies of deeds to Real Property
Nuptial Agreements (both pre-nuptial and post-nuptial)
Separation Agreement
Divorce Agreement (and Decree if available)
Gift Tax Returns
Life Insurance Policies
Advance Directives such as a Living Will, Health Care Power Of Attorney, and Do Not Resuscitate Order
Buy-Sell Agreements for Businesses or Partnerships
Trust Agreements