Life Plan Questionnaire
Your answers to these questions will assist me with properly advising you with your life planning. Please do your best to answer everything that is applicable. I look forward to helping. You will be relieved when we are done. Please disregard any questions that do not apply to you. A complete Life Care Plan includes the following: 1) Last Will and Testament- instructions for who gets your stuff and how you want to be buried; 2) Guardianship- if you have minor kids, this is the person who will raise them if something happens to you; 3) Trust- basically a bucket where you will put certain assets and designate how they are distributed; and 4) Health Care Directive and Health Power of Attorney- Instructions to doctors and a person you trust to make health decisions for you if you can not; 5) Durable Power of Attorney- If you give someone a Durable Power of Attorney, they will have all power to act on your behalf from now until your death(unless you change your mind). This will avoid the need for a lengthy court proceeding to have someone appointed if you are incapacitated.
Email address *
Please Choose All that apply to you: *
Required
Please Choose One: *
PERSONAL INFORMATION
Your full legal name, address, and phone number: *
Your Date of Birth: *
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Spouse full legal name, address, phone number, and e-mail.
Spouse Date of Birth:
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LAST WILL DETAILS
What are your burial wishes? *
Do you have a prepaid burial plan?
Clear selection
If you have a prepaid burial plan, please provide the name of the facility, address, and phone number:
Please select all that apply: *
Required
Specific Gifts: If you have specific gifts you would like to leave for specific people, please list the details here. Example- "Diamond wedding ring- to Jane Doe"
Charities: If you have specific charities you would like to leave assets to, please provide the details here.
CHILDREN INFORMATION
Provide names, dates of birth, addresses, phone, and emails for all children from oldest to youngest:
APPOINTMENT OF GUARDIAN
The guardian (guardians if you choose a couple), will be the person/persons who will raise and care for your children should something happen to you and your spouse. You should discuss this with the person/persons you have chosen.
Guardian/Guardians: Who do you choose to raise your children if something happens to you and your spouse? Please provide name, relation to you, address, phone, and email. If you wish to appoint a husband/wife as co-guardians, please also list the spouse.
Alternate Guardian: Please provide the same info as the previous question in the event your first choice for guardian can not serve.
APPOINTMENT OF EXECUTOR
The executor will be the person responsible for hiring an attorney and pushing your will through the court process. They will be responsible for taking an inventory of all your assets, selling your assets and distributing them per you wishes. This can be a person you are naming to inherit something in your Will.
Executor: Provide the name, relation to you, address, phone, and email of the person you wish to serve as the executor of your estate. *
Alternate Executor: Provide the same information for an alternate executor if your first choice can not serve.
APPOINTMENT OF TRUSTEE:
If you have chosen to have a Trust, for example to make sure your children receive assets at certain times, you will need to appoint someone to manage the Trust for the beneficiary/beneficiaries. This can be a money management firm or bank, but I recommend choosing someone you know and trust. They should have a good grasp on managing money and have a reputation of making good, responsible decisions.
Trustee: Who do you choose to manage and distribute the proceeds of your Trust? Please provide name, address, phone, and email.
Alternate Trustee: Provide the same information for an alternate executor if your first choice can not serve.
FINANCIAL INFORMATION
I do not wish to pry into your financial status. However, if you believe your Estate total estimated value could be in excess of $10 million dollars, you should include values and amounts. If you do not believe the value is en excess of $10 million dollars, you do not need to include values and amounts. However, please list the existence and location of the assets. This will greatly assist your executor if something happens to you.
Bank Accounts: Please list all accounts including bank name, account type(checkin, savings, etc.), owner, and whether you have named someone as POD(payable on death).
Certificates of Deposit:Please list all accounts including bank name, account type(checkin, savings, etc.), owner, and whether you have named someone as POD(payable on death).
Life Insurance & Annuities: Please list the name of the institutions where all policies are located, phone number, and beneficiaries currently named.
Real Estate: Please provide the address of all property owned by or in which you have an interest.
Personal Property: Please provide a description of all personal property owned by you and the approximate values.
Debts: Please list debts including name, address, and phone of lender and amount owed.
HEALTH CARE DIRECTIVE/HEALTH CARE POWER OF ATTORNEY
A Health Care Directive provides instructions to doctors and your family as to your medical wishes if you are in an incapacitated or vegetative state. You will need to name someone to make these decisions for you if needed. Choose someone who knows you well, and with whom you have discussed your wishes. Close family members are not always the best choice as these decisions can be emotional and difficult.
Who do you appoint to make health care decisions for you if you become incapacitated? Provide name, address, phone, and email.
Alternate health care decision maker: provide the name, address, phone, and email of health care decision maker in case your first choice can not serve.
If you become incapacitated and the chances of your recovery are slim, do you want your life prolonged?
Clear selection
If you become incapacitated and the chances of your recovery are slim, do you want to be provided artificial nutrition and hydration?
Clear selection
If you become incapacitated and the chances of your recovery are slim do you wish to receive treatment for alleviation of pain or discomfort even if it may hasten your death?
Clear selection
Durable Power of Attorney
A durable power of attorney gives someone the ability to make all decisions for you right now. The purpose is to have someone standing by to handle all your banking, real property, bills, etc. in case you become incapacitated. This power can be revoked at any time prior to your incapacity. This person should be someone who is very close to and trusted by you.
1st Choice: Provide the name, address, phone, and email of your first choice.
Alternate: Provide the name, address, phone, and email of an alternate in case the first choice can not serve.
A copy of your responses will be emailed to the address you provided.
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