WILL QUESTIONNAIRE Name of the client (testator): Other names sometimes used: Address (and County): __male __female __married [__once/__several] __widow(er) __divorced __single __previously made a Will - date(s): Telephone number(s): Name of spouse: Other names sometimes used: Children: __NONE __1 __2 __3 __4 Number: ___ __more children are anticipated __no child, but children are anticipated Adopted children are to be __expressly included, __expressly excluded or __this Will is to be silent on the subject. Enter the names and birthdates of the children (and indicate if minor, deceased with issue, by prior marriage, adopted, and any special treatment): Are you providing for the care of any person with special needs? If so, please provide details: Approximate assets of the testator: $ If you have included life insurance, please identify: Policy: Insurance Company: Insured: Beneficiary: Amount: Assets anticipated on death (including assets which may be inherited from spouse or otherwise): $ __real estate is to be disposed of under this Will - ___the spouse is to be the beneficiary of all real estate [__the property is to be sold if spouse predeceases] ___just the house to the spouse (other real estate to pass in residuary estate) ___all real estate is to pass in residuary estate ___all real estate is to be sold ___to one or more other beneficiaries (identify beneficiaries and shares if unequal): Identify the property: How are the personal effects and other tangible personal property to be bequeathed - __all to the spouse __as per a schedule (items not specified to the spouse) __as per a schedule (items not specified to pass in residuary estate) __all to the children __as provided with regard to the residuary estate __all to one beneficiary (enter name): __OTHER (describe disposition and shares): __there are to be specific cash bequests (enter amounts and beneficiaries): The residuary estate is to be bequeathed as follows - __to the spouse outright __if spouse predeceases, to issue per stirpes __to children and issue of the testator, per stirpes [__outright or __in trust] __to one beneficiary outright __to one beneficiary in trust __to more than one beneficiary, in __equal or __unequal shares, either outright or in trust Enter any specifics: __ designate alternate beneficiaries (as opposed to having residuary estate pass as if the testator died intestate). The alternate beneficiary may be an individual, entity or group of people, and you can designate a series of successor alternate beneficiaries: A beneficiary is to be deemed a "minor", whose legacy should be held in trust, if he is under the age of - __18 __19 __21 or for larger estates - __25 __30 __25 but 1/2 of the legacy is to be released when 21 __30 but 1/3 is to be released when 21, and 1/3 when 25 __35 but 1/3 is to be released when 25, and 1/3 when 30 __Other: If a child of the testator is a minor, are bequests to the child to be - __ paid, at the ELECTION of the executor, to the child, a guardian or a custodian under a Uniform Gifts To Minors Act, OR the executor may hold the bequest in trust (usually this option is best) __held in trust [by __a TRUSTEE or __the executor] until child attains majority Appoint as executor - __the spouse __the spouse and a co-executor __the spouse and one or more successor executor __one executor __one executor and one or more successor executor __two co-executors If a co-executor fails to qualify - __the other may act alone __the other may appoint a new co-executor __another co-executor is to be designated in this Will Enter the name(s) and relationship to the testator: IF THERE IS TO BE A TRUST - Appoint - __one trustee __one trustee and one or more successor trustee __two co-trustees If a co-trustee fails to qualify - __the other may act alone __the other may appoint a new co-trustee __another co-trustee is to be designated in this Will Enter the name(s) and relationship to the testator: __a trustee is also a beneficiary (if so, you should have a co-trustee) __income beneficiary is to be entitled to demand each year $5,000 or 5% of the principal of the trust __ create a single trust, rather than separate trusts, for minor children (permitting unequal payments) __ if a minor grandchild becomes a beneficiary, bequest must be held in trust (rarely - discretion to release to grandchild or guardian is preferable) __ trustee may liquidate a trust for a minor to the minor's guardian [__only if trust principal is less than $ ] If there are minor children, does the testator wish to appoint - __one guardian __a guardian and one or more successor guardians __two co-guardians __no guardian is to be appointed in this Will Enter the name(s) and relationship: [NOTE: If children by a prior marriage or stepchildren are to be treated differently, please fill in specifics above.] Re the survivorship clause - __ the spouse is to be deemed to survive a common accident (this may reduce estate taxes to be paid by a couple, by shifting assets to the spouse pursuant to the marital deduction, and may be appropriate where testator's assets are large and the spouse's assets are relatively modest) __ survivorship is to be based on surviving for a prescribed number of days - __30 days OR __other: ANCILLARY DOCUMENTS - __a "living will" (withdrawing medical treatment if the testator is terminally ill) Enter names, addresses and tele. no. of agent or agents (including the spouse) to act if testator is incapacitated: __a statement re funeral arrangements - __cremation, __medical or scientific purposes, __buried with military honors, __other: __a general power of attorney [__expressly to survive incompetence] Names and addresses of persons to be appointed: __execution instructions, family tree affidavit and asset summary SPECIAL PROVISIONS (NOT APPLICABLE TO EVERYONE) Please Review this Section If : Your Assets Are More than $1.200,000 for a Married Couple: You Are the Beneficiary of a Trust You or Your Spouse Are a Foreign Person Wills rarely contain any of the following - __ a pour over of assets to an existing trust (property to be included, name and date of the trust) __ the exercise of a power of appointment given by a third party instrument (identify title and date of instrument, beneficiaries to be designated, outright vs trust) __ a charitable trust (wholly charitable vs lead vs remainder trust, annuity vs unitrust, property to be included, identity of charity and lead or remainder beneficiary, percentage per annum) __ the purchase of an annuity (beneficiaries, amounts) Enter the specifics: __create a credit shelter trust (estates over $600,000) - __fund trust with the maximum available credit [vs __amount that spouse disclaims or __fixed amount - $ ] __f/b/o spouse [__f/b/o spouse and children, sprinkling] __spouse is to have a limited power of appointment __f/b/o children [__cash bequest, __trust for minors, __in trust throughout lives of children] __f/b/o other beneficiaries [__cash bequest, __trust if minor, __in trust throughout life] Enter specifics: __ a marital deduction trust f/b/o spouse [__QTIP, __QTIP with limited power of appointment, __general power of appointment, __an "estate" trust] __spouse is foreign person (so QDT is to be created) __ executor to allocate the generation skipping tax (GST) exemption [__marital deduction trust to be split, with a separate trust for GST share] __ a minimum bequest to spouse (disinheriting spouse to the extent permitted by law) [balance to __the children or __other beneficiaries] Rarely do you ever - __require a bond from executor __request executor to waive his commission __expressly provide a bank's or trust company's commission shall be as per its published schedule __waive an inventory and account of proceedings by executor __provide for per capita, rather than per stirpes, distributions __direct payment or prepayment of debts __apportion estate taxes __expressly treat disclaimers of bequests __expressly disinherit one or more persons (other than the spouse) - name(s)and relationship(s): __provide an "in terrorem" clause (there may be questions of enforceability in some jurisdiction) __permit 2207A election (re taxes if testator is beneficiary of QTIP trust) __include a "virtual representation" clause (to minimize need for guardian at litem in any proceeding) __have Will recommend attorney LIVING WILL QUESTIONNAIRE If you are (a) in a terminal condition, (b) permanently unconscious, (c) in a vegetative state, and/or (d) conscious but have irreversible brain damage and will never regain the ability to make decisions and express your wishes, would you want to specify what medical treatment[s] should be withheld? You may direct that treatment be limited to measures to keep you comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing life-sustaining treatment. You may also provide for organ donation for transplant, if you so desire. Please check here [_] if you want to be an organ donor. In addition, you should express your feelings about the following forms of treatment: Check boxes which apply: I do [ ] do not [ ] want cardiac resuscitation. I do [ ] do not [ ] want mechanical respiration. I do [ ] do not [ ] want tube feeding or any artificial form of nutrition (food) or hydration (water). I do [ ] do not [ ] want blood or blood products. I do [ ] do not [ ] want any form of surgery or invasive diagnostic tests. I do [ ] do not [ ] want kidney dialysis. I do [ ] do not [ ] want antibiotics. [ ] Other Instructions: If you wish to designate another person as a surrogate to make life-sustaining treatment decisions for you if you should be incompetent and in a terminal condition or in a state of permanent unconsciousness (designated surrogate is not authorized to consent to the withholding or withdrawal of artificial nutrition and hydration unless you have provided specific directions): Name and Address of Surrogate: Name and Address of Substitute surrogate (if surrogate designated above is unable to serve): NOTE: THIS QUESTIONNAIRE IS NOT THE ACTUAL LIVING WILL. IT MUST BE IN A SPECIAL FORM AND EXECUTED UNDER CERTAIN CIRCUMSTANCES AND WITH PROPER WITNESSES TO BE EFFECTIVE. Documents to Bring to Your Meeting. Use the following checklist to identify documents to collect for your initial estate planning meeting: Personal financial statement (e.g. for a bank loan) Recent brokerage statements Wills Trusts Powers of Attorney Living Wills Guardian Appointments Shareholder Agreements Corporate kits Corporate tax return Partnership Agreements Partnership tax return LLC Operating Agreement Buy-out Agreements Prenuptial Agreement/Separation Agreement Federal Income Tax Returns (most recent year) Cover page of each insurance policy Deed for any real estate (including your house) Leases for significant properties Any other important documents Provide copies, not originals. Include any other documents which may be important to your planning process. Copyright 2008 Miriam N. Jacobson http://www.miriamjacobsonlaw.com http://www.realtyandestateslaw.com