Estate Questionnaire - Law Offices of Thomas P. Miller, P.C.
Please complete and Submit
Today's Date
MM
/
DD
/
YYYY
Which of the following do you authorize us to send you the following by e-mail
I. Your Information
Full name
Your answer
E-mail
Your answer
Telephone number
Your answer
Home address
Your answer
Date of birth
MM
/
DD
/
YYYY
Your spouse's full name
Your answer
II. Heirs and Beneficiaries
You must list all your children (heirs) and all people you want to receive under your Will (beneficiaries).
Child 1: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Address
Your answer
Child 2: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Address
Your answer
Child 3: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Address
Your answer
Child 4: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Address
Your answer
Other Person You Want to Provide For 1: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Relationship to you
Your answer
Address
Your answer
Other Person You Want to Provide For 2: Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Relationship to you
Your answer
Address
Your answer
III. Executors
An executor will make sure that what your will states is done. A successor acts if the executor cannot or does not want to act.
Executor Name
The executor must administer the Will for the beneficiaries' benefit.
Your answer
Executor Address
Your answer
Successor Executor Name
Your answer
Successor Executor Address
Your answer
IV. Guardian of Minor Children (if any)
A guardian is someone that you want to care for your children if you and the child's other parent are gone.
First Choice: Name
Your answer
First Choice: Address
Your answer
Second Choice: Name
Your answer
Second Choice: Address
Your answer
V. Children's Trust
Do you want a Children's Trust
Until what age do you want the trust to be effective?
Your answer
Trustee: Name
The trustee will control the distribution of the money for the child's benefit.
Your answer
Trustee: Address
Your answer
Successor Trustee: Name
Your answer
Successor Trustee: Address
Your answer
VI. Additional Information Bequests
List any specific directions. These may include specific items you want to go to specific beneficiaries, or you can list heirs (such as children) that you do not want to inherit anything.
Your answer
VII. Power of Attorney - Healthcare
This person will make healthcare decisions for you whenever you cannot.
Event or date that you want the Power of Attorney for Healthcare to become effective
Your answer
First Choice for POA: Name
Your answer
First Choice for POA: Address
Your answer
Second Choice for POA: Name
Your answer
Second Choice for POA: Address
Your answer
VIII. Power of Attorney - Property
This person will make financial decisions for you whenever you cannot.
Event or date that you want the Power of Attorney for Healthcare to become effective
Your answer
First Choice for POA: Name
Your answer
First Choice for POA: Address
Your answer
Second Choice for POA: Name
Your answer
Second Choice for POA: Address
Your answer
IX. Miscellaneous
How did you find us? Please provide name of person who referred you or website.
Your answer
If you need more space to answer any of the above questions, please use this space.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service