Wills & Estate Documents Questionnaire

Privileged and Confidential

WILLS & Estate DocuMEnts QUESTIONNAIRE©
(FIRE, POLICE & EMTs)
(LONG FORM - UPDATED 2/12/12)

ALL INFORMATION PROVIDED ON THIS FORMIS PRIVILEGED AND CONFIDENTIAL

PLEASE KEEP A COPY OF THIS QUESTIONNAIRE FOR YOURSELF.

Your volunteer will use the information provided in response to this Questionnaire to prepare your Will as well as any other estate documents you request. While this form may seem lengthy at first, once started, it generally takes no more than 45 minutes to complete. Our goal and the purpose of having you complete this Questionnaire is to provide you and your spouse with a comprehensive set of estate documents that accurately reflect your wishes. After your volunteer reviews your completed Questionnaire, they may also call you to discuss any questions they have, as well as any questions you may have.

If your wishes are different than the choices available on this form, please write them out so that your volunteer can draft documents that reflect your wishes. (Attach additional sheets, if necessary.) Also, feel free to skip any parts of this Questionnaire that do not apply to you. If you have already identified and provided information about a person in a previous section of this form, then you do not have to restate that same personal information again. If you would like your volunteer to prepare a Will or other estate documents for your spouse, fiancé or domestic partner, they should complete their own separate Questionnaire.

Your full legal name: /

FirstMiddleLast(No initials, please)

Do you use a maiden name or nickname? / Yes No /

(If yes, please write your other name here)

I am/my spouse is employed by the following service: Fire Police EMT

If your spouse is the civil servant, please provide their full name? /
What city, station/precinct are you/your spouse assigned? /

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What documents[1] would you like your volunteer to prepare for you?

Will? Yes No. If “Yes”, please complete PART 1 (pages 3 – 19).

Advance Health Care Directive? Yes No. If “Yes”, please complete PART 2 (pages 20 - 24).

Financial Power of Attorney? Yes No. If “Yes”, please complete PART 3 (pages 25 - 27).

Standby Guardianship for your Minor Child? Yes No. If “Yes”, please complete PART 4 (pages 28 - 29).

Nomination of Guardianship/Conservatorship for you, your spouse, child or parent? Yes No. If “Yes”, please complete PART 5 (pages 30 - 31).

Questions, concerns or comments about any part of this process? Yes No If “Yes”, please complete PART 6(page 32)or contact your volunteer.

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How may we contact you?(Please check all that apply.)

Home phone: / / Best time to call: /
Work phone: / / Best time to call: /
Cell phone: / / Best time to call: /
E-mail address: /
Other: /

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WE APPRECIATE YOUR SERVICE & LOOK FORWARD TO SERVING YOU!

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Please MAIL your completed Questionnaire to:

Ms. Jamese Geathers

Atlanta Volunteer Lawyers Foundation

Suite 1750NorthTower

235 Peachtree Street, NE

Atlanta, Georgia 30303,

or

FAX your completed Questionnaire to: 404-521-3434 c/o Jamese Geathers;

or

PDF your completed Questionnaire to: .

and

If you have any questions, please call your volunteer or Jamese Geathers at: 404-521-6000.

Part 1 – Your Will
A Will allows you to: identify who should inherit your property upon your death; appoint a guardian and conservator for your minor children upon your death; and set up a trust to protect the inheritance of minor children or incapacitated adults. A Will does not become effective unless and until your death.
YOU
We need to know some basic information about you in order to properly draft your Will. For example, the place where you live or have lived and your citizenship may dictate the laws governing the creation of your Will and the division of your property. Likewise, relatives through blood or marriage may be entitled to make a claim against the property to be distributed from the estate created under your Will.

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Your home address: /
City: / / County: / / State: / / Zip: /
Your date of birth: / / Are you a U.S. citizen? Yes No

Are you currently married? Yes NoAre you currently separated? Yes No

If you are married, do you want a divorce? Yes No

Have you ever been married before? Yes NoDivorced Widowed

Are you engaged, or do you intend to get married in the next 24 months? Yes No

Are either of your parents living? Yes-Father Yes-MotherNo

Do you have any living brothers or sisters? Yes No

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YOUR SPOUSE
If you are currently married, we need to know some basic information about your spouse since they may be entitled to certain property to be distributed from the estate created under your Will.
Your spouse’s full legal name: /

FirstMiddleLast(No initials, please)

Is your spouse known by any other name? Yes No /

(If yes, please write spouse’s other name here)

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Spouse’s home address: /
City: / / County: / / State: / / Zip: /
Spouse’s date of birth: / / Is your spouse a U.S. citizen? Yes No

Other states where you and your spouse have lived since your wedding:

(If you and your spouse have lived in a community property state, it may impact the preparation of your Will)

Was your spouse married previously? Yes NoDivorced Widowed

Are your spouse’s parents living? Yes-Father Yes-Mother No

Does your spouse have any living brothers or sisters? Yes No

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YOUR CHILDREN AND DEPENDANTS
If you have children, regardless of age, whether through birth or adoption, we need to know some basic information about each child as they may be entitled to certain property distributed from the estate created under your Will.

Do you have any children? Yes NoAny deceased children? Yes No

Do you have any grandchildren? Yes No

Do you plan to give birth or adopt children in the future?

Currently expectingAdoption in progressMaybe laterNo

Please list each child(or other person for whom you provide care and support), regardless of age, and check each item that applies. (Attach additional sheets, if necessary.)

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Child’s full name: / / Date of birth: / / Age: /

Yours and Spouse’sYours Spouse’sLives at home Lives somewhere else

Child’s home address: /
City: / / State: / / Zip: /

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Child’s full name: / / Date of birth: / / Age: /

Yours and Spouse’sYours Spouse’sLives at home Lives somewhere else

Child’s home address: /
City: / / State: / / Zip: /

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Child’s full name: / / Date of birth: / / Age: /

Yours and Spouse’sYours Spouse’sLives at home Lives somewhere else

Child’s home address: /
City: / / State: / / Zip: /

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Child’s full name: / / Date of birth: / / Age: /

Yours and Spouse’sYours Spouse’sLives at home Lives somewhere else

Child’s home address: /
City: / / State: / / Zip: /

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Child’s full name: / / Date of birth: / / Age: /

Yours and Spouse’sYours Spouse’sLives at home Lives somewhere else

Child’s home address: /
City: / / State: / / Zip: /

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YOUR REMAINS
It is traditional for a Will to state any instructions you may have concerning your funeral, memorial service or the treatment of your remains at the time of your death. However, since a Will is often not read until a week or more after death, please make sure that your loved ones know your desires while you are still living, to make sure your burial instructions are followed. Absent instructions in your Will, the Health Care Agent listed inyour Advance Directive has the authority to decide what happens with your remains in accordance with your wishes, or alternatively they may be given general authority to decide on their own. Therefore, it is important that any burial instructions expressed in your Will be consistent with the burial instructions expressed to your Health Care Agent in your Advance Directive.

Do you have a preference with regard to memorial services or a monument? Yes No

If “yes”, please state your wishes: /

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Do you have a preference with regard to burial or cremation? Yes No

Burial – Cemetery address: /
City: / / State: / / Zip: /

Cremation Ashes deposited in the following location(s):

Ashes distributed to the following person(s):

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YOUR HOME, LAND & REAL PROPERTY
It is traditional for a Will to identify each person (“Beneficiary”) who you wish to receive any legal interest which you may have in land or real property at the time of your death. You should identify any homes, land or real property in which you have a legal interest, whether through sole ownership, joint ownership or through a lease, regardless of whether such property is financed or mortgaged. The form of ownership may have an impact upon whether the property may be transferred under your Will. For example, jointly owned property held through a “Tenancy in Common” may be transferred under a Will, whereas, jointly owned property held through a “Joint Tenancy with rights of survivorship” may not be transferred under a Will. You always have the right to sell or give land or real property away prior to your death. However, if you still own the property at the time of death, then the Beneficiary will become the new owner.

Do you own or lease a home, house, building, land or any real property (regardless of financing)? Yes No

Property address: /

(Attach additional sheets, if necessary)

City: / / State: / / Zip: /

Does anyone else own or lease your home or land with you? Yes No

If yes, who owns or leases the home or land with you? /

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Please identify the person(s) you wish to name as a Beneficiary who will inherit your home, land or real property upon your death, along with the real property and percentage of ownership they should receive. (Attach additional sheets, if necessary.)

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Address of real property and percentage of ownership to be received: /

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Address of real property and percentage of ownership to be received: /

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Please identify the person(s) you wish to name as a Back-up Beneficiary who will inherit your home, land or real property in case one or more Beneficiaries die before you? (Attach additional sheets, if necessary.)

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Address of real property and percentage of ownership to be received: /

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Address of real property and percentage of ownership to be received: /

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YOUR TANGIBLE PERSONAL PROPERTY
It is traditional for a Will to identify each person (“Beneficiary”) who you wish to receive any legal interest which you may have in tangible personal property. Tangible personal property includes personal effects, furniture, clothes, cars, collections, jewelry, electronics, knick-knacks, and so forth, as distinguished from money, bank accounts, and securities. You may always sell or give personal property away prior to your death. However, if you still own the property at the time of death, then the Beneficiary will become the new owner.

Do you want to give any specific personal property to a particular person? Yes No

(If “yes,” please identify the specific property and who should receive it below. Otherwise you can simply give all of your personal property to one or more of the persons listed below)

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Please identifythe person(s) you wish to name as a Beneficiary who will inherit your personal property upon your death. (Attach additional sheets, if necessary.)

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of personal property to be received: /

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of personal property to be received: /

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Please identify theperson(s) you wish to name as a Back-up Beneficiary who will inherit your personal property in case one or more Beneficiaries dies before you? (Attach additional sheets, if necessary.)

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of personal property to be received: /

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of personal property to be received: /

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YOUR CASH, BANK ACCOUNTS & INVESTMENTS
It is traditional for a Will to identify each person (“Beneficiary”) who you wish to receive any legal interest which you may have in cash, bank accounts and other investments. Investments include stocks, bonds, certificates of deposit and all other types of securities that do not identify a Beneficiary in the event of death. You may always use, trade or give away your cash, bank accounts and investments prior to your death. However, if you have a legal interest in such property at the time of death, then the Beneficiary shall inherit this legal interest.

Do you want to give a cash amount or a specific investment to a particular person? Yes No

(If “yes,” please identify the specific amount or investment. Otherwise, you can simply give all of your cash, bank accounts and investments to one or more of the persons listed below)

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Please identifytheperson(s) you wish to name as a Beneficiary who will inherit your cash, bank accounts and investments upon your death. (Attach additional sheets, if necessary.)

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of account/investment and amount to be received: /

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of account/investment and amount to be received: /

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Please identify the person(s) you wish to name as a Back-up Beneficiary who will inherit your cash, bank accounts and investments in case one or more Beneficiaries dies before you? (Attach additional sheets, if necessary.)

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of account/investment and amount to be received: /

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of account/investment and amount to be received: /

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YOUR REMAINING PROPERTY
It is traditional for a Will to identify each person (“Beneficiary”) who you wish to receive any legal interest which you may have in remaining property not otherwise mentioned or covered in your Will. Remaining property includes everything from intangible property such as copyrights and patents to unclaimed lottery tickets or inheritances from others. You may always use, trade or give away your remaining property prior to your death. However, if you have a legal interest in such property at the time of death, then the Beneficiary shall inherit this legal interest.

Please identifythe person(s) you wish to name as a Beneficiary who will inherit your remaining property upon your death. (Attach additional sheets, if necessary.)

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of residual property to be received: /
Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of residual property to be received: /

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Beneficiary’s full name: /
Beneficiary’s age: / / Relationship to You: /
Beneficiary’s address: /
City: / / State: / / Zip: /
Description of residual property to be received: /

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Please identify the person(s) you wish to name as a Back-up Beneficiary who will inherit your remaining property in case one or more Beneficiaries dies before you? (Attach additional sheets, if necessary.)

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of residual property to be received: /

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Back-up Beneficiary’s full name: /
Back-up Beneficiary’s age: / / Relationship to You: /
Back-up Beneficiary’s address: /
City: / / State: / / Zip: /
Description of residual property to be received: /

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YOUR EXECUTOR
It is traditional for a Will to identify a person (“Executor”) who will be responsible for administering your Will. Any individual who is over the age of 18 may serve as the Executor responsible for distributing your property and fulfilling all of the instructions contained in your Will. Your spouse may serve as Executor, but that is not required. Your Executor does not have to live in the same state as you, but it will be much easier for a local Executor to administer your estate than for an Executor who lives someplace else. Many banks will serve as Executor, but they charge a fee for doing so. Your Executor need not be a lawyer or a financial expert, but your Executor has very broad powers with regard to your property. Therefore, your Executor should be someone who is intelligent enough to ask for help from professionals when needed (accountants, lawyers, investment advisors, etc.), is honest and completely trustworthy, and is responsible enough to “get things done” and see them through to completion.

Please identify theperson you wish to serve as the Executor who will administer your Will.

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Executor’s name: /
Executor’s age: / / Relationship to You: /
Executor’s home address: /
City: / / State: / / Zip: /

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