Information for preparation of
Will/trust agreement
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For: |
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Home Address: |
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E-mail Address: |
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Telephone: |
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Data as of: |
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In completing this form, kindly supply proper names – given first name, middle initial or name, and last name. If known by any other name, please supply. Please supply supplemental sheets for any additional information. |
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Names to be used |
Address & Citizenship |
Age or Date
of Birth |
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Husband: |
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Wife: |
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Children:
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Grandchildren:
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Living Parents:
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H. |
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H. |
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H. |
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W. |
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W. |
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W. |
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Other Information:
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Business: |
Address: |
Telephone #: |
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Position: |
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Company:
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Insurance Agent:
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Stock Broker:
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Accountant:
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Location of Safe Deposit Box:
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Husband’s Social Security Number:
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Wife’s Social Security Number:
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Indicated dispositive plan
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(1)Specific bequests of personal effects.
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Legatee |
Residence |
Relationship |
Legacy
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(2)Balance of personal effects.
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Legatee |
Residence |
Relationship |
Legacy
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(3)Bequests of cash.
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Legatee |
Residence |
Relationship |
Amount
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(4)Real Estate.
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Legatee |
Residence |
Relationship |
Property
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(5)Other.
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Legatee |
Residence |
Relationship |
Property
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(6)Balance of Property.
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(a)OUTRIGHT.
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(i)Children: |
% |
Other: |
%
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Grandchildren: |
% |
Charity: |
%
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Name and residence of other/charitable legatees:
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(ii)Upon death of husband and wife.
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Children: |
% |
Other: |
%
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Grandchildren: |
% |
Charity: |
%
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(a)IN TRUST:
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Income of Trust (check one or more categories)
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Children: |
% |
Other: |
%
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Grandchildren: |
% |
Charity: |
%
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Other: |
%
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Name and residence of other/charitable legatees:
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(ii) Distribute trust principal at life or age
21, 25, 30, etc.
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Provisions for children, grandchildren or other named beneficiaries do not survive.
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Special provisions desired.
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Executor/Executrix of Will.
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NAME |
RELATIONSHIP |
RESIDENCE
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ALTERNATES:
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NAME |
RELATIONSHIP |
RESIDENCE
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Trustees of Will/Trust Agreement.
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NAME |
RELATIONSHIP |
RESIDENCE
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ALTERNATES:
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NAME |
RELATIONSHIP |
RESIDENCE
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Guardians of minor children.
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NAME |
RELATIONSHIP |
RESIDENCE
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ALTERNATES:
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NAME |
RELATIONSHIP |
RESIDENCE
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ASSETS AND LIABILITIES
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ASSETS |
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In H’s name |
In Joint Names |
In W’s Names
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(1) Bank Accounts |
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Savings |
$ |
$ |
$
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Checking |
$ |
$ |
$
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(2) Bonds |
$ |
$ |
$
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Stock |
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Public Corp. |
$ |
$ |
$
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Private Corp |
$ |
$ |
$
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Real Estate |
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In home state |
$ |
$ |
$
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In other states |
$ |
$ |
$
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Tangible personal property |
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Jewelry/Collectibles |
$ |
$ |
$
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Furnishings |
$ |
$ |
$
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Other |
$ |
$ |
$
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Life Insurance
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Husband:
Group
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$ |
$
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Ordinary Life:
Fair Value $
Cash Value $
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$ |
$
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Beneficiaries
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$ |
$
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Wife:
Group
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$ |
$
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Ordinary Life:
Fair Value $
Cash Value $
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$ |
$
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Beneficiaries
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$ |
$
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Employee Benefits
Husband |
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IRA
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$ |
$
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401(K) or 403(B)
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$ |
$
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Pensions
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$ |
$
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Beneficiaries:
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Employee Benefits
Wife |
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IRA
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$
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$
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401(K) or 403(B)
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$
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$
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Pensions
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$
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$
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Beneficiaries:
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(8) Business Interests |
$ |
$ |
$
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(9) Other Assets |
$
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$
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$
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(10) Expectancies |
$
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$
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$
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LIABILITIES
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Mortgages |
$ |
$ |
$
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Bank Loans |
$ |
$ |
$
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Notes |
$ |
$ |
$
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Other |
$ |
$ |
$
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TOTAL
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____________
$ |
____________
$ |
____________
$ |
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Description of others:
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