General Information

1)    Your name:               

2)    Your email address:  

Last Will & Testament Questionnaire

1)    Complete Name of Testator or Testatrix:

    
  
2)    Date of Birth:

    

3)    City and State of Birth:

    

4)    Marital Status / Name of Spouse:

    

5)    Names of Children:

    

6)    Persons intentionally excluded from Will:

    

7)    Personal Representative:

    

8)    Successor Personal Representative:

    

9)    Distribution:

    

10)  If this individual does not survive me, my residuary estate
        shall be distributed as follows (check one):
   
       Equally            Percentages

11)    Successor Beneficiaries:

    

12)    If any child of mine does not survive me and has no
          children who survive me, such deceased child’s
          share shall be distributed in equal share to my other 
          children.  In the event my spouse and children and
          their children do not survive me, the distribution of
          my residue property goes to:

    

13)    Disposition of remains (check one):

       Burial            Cremation

14)    Names and addresses of witnesses: