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Will Intake Form

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Will Intake Form

Will is for:

Your Name

Today's Date

Social Security Number:

Date of Birth:

Address

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Have you made a previous will?

Do you have a Power of Attorney?

Do you have a Health Care Proxy?

Have you filed a Homestead exemption?

If yes, what is the property address?

Marital Status:

Date of Marriage:

Spouse First Name

Spouse Last Name

Spouse Date of Birth:

Spouse Social Security Number:

Do you have children?

First and last names of children and date of birth of each:

Are any of your children of a previous marriage?

I wish to appoint the following guardian of my minor children to age

First Name of Guardian

Last Name of Guardian

Address of Guardian:

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

If unable to serve or predeceases me, I nominate as contingent:

Contingent First Name

Contingent Last Name

Address of contingent:

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

I wish to appoint as Executor (trix) to carry out the terms of my Will:

Executor First Name

Executor Last Name

Address of Executor(trix):

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

My second choice as Executor(trix):

Second Executor First Name

Second Executor Last Name

Address of Second Executor(trix):

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

The beneficiary of my Will:

Beneficiary First Name

Beneficiary Last Name

Address of beneficiary :

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

The Second beneficiary of my Will:

Second Beneficiary First Name

Second Beneficiary Last Name

Address of Second beneficiary :

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

The Third beneficiary of my Will:

Third Beneficiary First Name

Third Beneficiary Last Name

Address of Third beneficiary :

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Relationship to you:

Name of any person who would normally be listed but are being passed over:

Additional Person First Name

Additional Person Last Name

Name of any additional person

First Name

Last Name

Name of any additional person (3)

First Name

Last Name

Will Intake Form

If unable to serve or predeceases me, I nominate as contingent:

I wish to appoint as Executor (trix) to carry out the terms of my Will:

My second choice as Executor(trix):

The beneficiary of my Will:

The Second beneficiary of my Will:

The Third beneficiary of my Will:

Name of any person who would normally be listed but are being passed over:

Name of any additional person

Name of any additional person (3)

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Ford, Quinn & Associates, P.C.

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