Part 1- Personal Information

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If you are single, skip to Part 2. If you are married, please fill out the information below, about your spouse:

Part 2- Relationships

For any child(ren) you have, please list their full legal name(s) and date(s) of birth in the text box below: 

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In the text box below, list any individuals (grandkids, siblings, parents, friends,etc.) or charities that you have considered leaving money or property to under your estate plan. For each, include their full legal name, date of birth, and relationship to you.

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Part 3- Assets and Liabilities

In the text box below, list your assets and their estimated value as of today's date. Describe the asset in some general way (e.g., bank name (checkings/savings), car make/model, investment broker, insurer, or address for real estate). Do not list account numbers or other sensitive information. 

Please include any sentimental items that you wish to specifically leave to beneficiaries under your will. 

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For each life insurance policy you own, please list the following information:

  • Insurance company

  • Type of policy

  • Insured

  • Owner

  • Beneficiary(ies) 

  •  Face value/ Cash value 

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Please provide a summary of your liabilities, including debtor and total owed. Consider: mortgage, student loans, credit cards, personal loans, business loans, etc. 

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Part 4- Estate Plan Design Information

If you have children under the age of 18, list in order of preference whom you wish to be guardian of your minor children (list a first and second choice):

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Who would you like to be the Executor of your Estate? Please list a first and second choice. 

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Please list your first, second and third choice for Financial Power of Attorney. This agent has the authority to manage your financial affairs for you. 

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Please list your first, second and third choice for Health Care Power of Attorney. This agent has the authority to make health care decisions for you if you are not able to communicate or make informed decisions for yourself. 

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Would you like a Living Will? 

Please use the space below to tell us anything important that you would like us to know regarding your estate plan: 

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