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Estate Planning Questionnaire

BASIC INFORMATION FOR THE EXECUTOR(S)

The Settlor is the person (or persons) who establish(es) and create(s) a last will and testament of assets that make up the probate.


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Row ID Full Name Gender: Address Home Phone Work Phone County Cell Phone Fax Number Date of birth Place of Birth Are you U.S. citizen? Actions
                       
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IF MARRIED :


MM slash DD slash YYYY
Hidden
Do you have Prenuptial Agreement?
Do you have separate property?
Do you own property with someone other than spouse?

LAST WILL AND TESTAMENT QUESTIONNAIRE


EXECUTOR - REFERS TO A MALE

EXECUTRIX - REFERS TO A FEMALE


Normally this is your spouse. If this is your first selection, check here , then go to 2nd Choice.

Row ID Executor/Executrix Relationship Address Phone number Email County Actions
             
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DURABLE POWER OF ATTORNEY - PROPERTY & FINANCIAL


The person(s) named in this section will have the authority to handle all of your personal and business affairs should you become mentally or physically incapacitated. The document is designed to become effective upon execution and should be kept in a safe place until your disability or until you voluntarily activate it by delivering it to your agent. You should consider their proximity to you, business skills, knowledge of your risk tolerance and estate planning goals.

Row ID Power of Attorney Relationship County Address Phone number Email Actions
             
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Do you own property in Florida?

DURABLE POWER OF ATTORNEY - HEALTH CARE

The person(s) named in this section will have the authority to handle all of your health care decisions should you become mentally of physically incapacitated. These decisions might include what doctor or hospital to use and wether or not to allow surgery if needed. The document is designed to become effective immediately, and therefore, SHOULD BE DELIVERED TO YOUR AGENT upon your disability and SHOULD always be subject to you express wishes.

Row ID Power for Attorney Relationship County Address Phone number Email Actions
             
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You will also receive a


LIVING WILL (DECLARATION),


whhich will act as a directive if your health care agent is unable to fulfill his/her duties and a

HIPAA PATIENT AUTHORIZATION


which will act as a directive to any health care provider or insurance company to release your records to your authorized agent.

GENERAL INFORMATION

NAMES OF ALL YOUR CHILDREN - LIVING OR DECEASED

Row ID Name of child Gender Living / Deceased Birth Date From Current or Prior Marriage Is the child Disabled? Actions
             
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NAMES OF YOUR GRANDCHILDREN - LIVING OR DECEASED

Row ID Name of child Gender Living / Deceased Birth Date Child of Is your grandchildren disabled? Actions
             
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Please specify how you want your estate to be distributed

SPECIFIC GIFTS OR ASSETS TO A SPECIFICALLY NAMED BENEFICIARY

Please identify any specific gifts of cash, stocks, bonds, or cash equivalents or real property that you wish to make a specific beneficiary.

Row ID Beneficiary Name Relationship Description of Bequest Actions
       
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ALTERNATE BENEFICIARIES

In this section, you identify the person or persons who would receive a beneficiary's share of the Trust Estate if that person fails to survive this distribution.

ALTERNATE BENEFICIARIES

GENERAL INFORMATION

GUARDIANSHIP FOR MINORS

A Guardian or Guardians shall be appointed for minor children (to age 18). This person(s) shall be appointed Guardian of the Estate and Guardian of the Person (usually the same person)

Do any children have disabilities?

SPECIAL DISTRIBUTIONS OF ASSETS

Please set any special distribution plans you may have for the distribution of a beneficiary's share of the Trust Estate.

Row ID Beneficiary Relationship Brief description of your Desires Regarding Distribution Actions
       
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REMAINDER BENEFICIARIES AFTER ALL OTHER PRIOR DISTRIBUTIONS

Please Identify the person or persons who will receive the remainder of your estate after the distribution of all of the above listed specific gifts, alternate beneficiaries and special distributions. You may designate either a specific dollar amount or a percentage of the assets.

Row ID Beneficiary Relationship Dollar Amount or Percentage Actions
       
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GENERAL INFORMATION (cont'd)

ASSET LIST

1. SALARY:
MM slash DD slash YYYY
SALARY (Spouse):
MM slash DD slash YYYY
2. REAL ESTATE:
Row ID Address Who Owns Approx. Value Amnt. Of Mortgage Percentage Rate Actions
           
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3. BANK ACCOUNTS:

Row ID Name of institution Type of account Please enter type of account: ACCOUNT TITLE NAME(S) OF ACCOUNT HOLDER Actions
           
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STOCK/BONDS

Row ID Name of institution Type of account Please enter type of account: ACCOUNT TITLE NAME(S) OF ACCOUNT HOLDER Actions
           
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BROKERAGE ACCTS

Row ID Name of institution Type of account Please enter type of account: ACCOUNT TITLE NAME(S) OF ACCOUNT HOLDER Actions
           
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RETIREMENT ASSETS

Row ID Beginning Date Name of institution Account Holder Who Owns Approx. Value Actions
           
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AUTOMOBILES

Row ID TITLE HOLDER YEAR AND MAKE INSURANCED BY: Actions
       
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PERSONAL PROPERTY:

Row ID Who Owns Approx. Value Item Actions
       
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LIFE INSURANCE:

Row ID Who Owns Approx. Value Face Value Type Actions
         
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