If your spouse is living at the time of your death, would your entire estate pass to your surviving spouse?
Clear selection
If you and your spouse die at the same time, or your spouse dies before you, who will receive your estate?
Your answer
If you have minor children, and you pass while they are still under the age of 18, who would you desire to be their legal guardian?
Your answer
If you answered the previous question, what is the address and telephone number of the person or persons you would propose as legal guardians/s of your minor child/ren?
Your answer
If your spouse is alive at the time of your death, would you want them to serve as the Personal Representative / Executor of your Estate?
Clear selection
Who is your first choice to serve as the Personal Representative / Executor of your Estate?
Your answer
How is this person related to you?
Clear selection
Who is your second choice to serve as the Personal Representative / Executor of your Estate?
Your answer
How is this person related to you?
Clear selection
Who is your third choice to serve as the Personal Representative / Executor of your Estate?
Your answer
How is this person related to you?
Clear selection
If one the people who would receive a share of your Estate died before you, would you want the person's share to pass to their children?
Your answer
If you were still living, but unable to handle your own financial affairs, who would you want to act as your Power of Attorney?
Your answer
How is this person related to you?
Clear selection
If you were unable to communicate or lacked ability to answer questions, who would your first choice be to make medical decisions for you?
Name, address, and best telephone numbers
Your answer
If you were unable to communicate or lacked ability to answer questions, who would your second choice be to make medical decisions for you?
Your answer
If you were unable to communicate or lacked ability to answer questions, who would your third choice be to make medical decisions for you?
Name, address, and best telephone numbers
Your answer
Do you consider yourself and organ donor?
Your answer
If you were unconscious, or unable to communicate, for whatever reason, with respect to any Life-Sustaining Treatment, which of the following statements do you think best describes your wishes?
Clear selection
If none of the above apply, describe in your own words your desire:
Your answer
With respect to Nutrition and Hydration provided by means of a nasogastric tube or tube into the stomach, intestines, or veins:
Clear selection
Your answer
If none of the above apply, describe in your own words your desire:
Your answer
If a child or young person were to receive a portion of your Estate, how old would you want them to be before they could have free access to their share?
Your answer
If they would not have access at age 18, would you want them to have limited access for college tuition and expenses?