Your Name: *

First Name

Last Name

Your Phone Number *

(###)

###

####

Primary Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse's Name (if applicable)

First Name

Last Name

Type of Plan *

Will Based Plan

Trust Based Plan

$30 Last Will & Testament

Name of person #1:

First Name

Last Name

Name of person #2:

First Name

Last Name

Name of person #3

First Name

Last Name

Distribution of Estate After Specific Gifts: *

To a named beneficiary

To children in equal shares, per stirpes (i.e., if any child predeceases you, such child's share is distributed among the children of such deceased child.)

To children, pro rata (i.e., if any child predeceases you, such child's share is allocated among your surviving children)

Trustee:

You (and your spouse if applicable) will serve as the initial Trustee(s). Following the death or incapacity of you and your spouse, the Trustee named in your Revocable Trust or Testamentary Trust is the person responsible for managing the property held by your Trust. The Trustee’s role includes a variety of administrative duties, such as accounting and reporting obligations, investment responsibilities and legal and tax compliance. The Trustee is also empowered to make discretionary distributions of Trust assets to some or all of the Trust beneficiaries. Please list the successor Trustees following the death of you and your spouse. Leave blank if you have a Will Based Plan and decided not to include a Testamentary Trust (i.e., if distributions will be made outright following your death). First Successor Trustee:

First Name

Last Name

Second Successor Trustee

First Name

Last Name

Executor (Personal Representative)

The Executor or "Personal Representative" named in your Last Will and Testament is the person responsible for (i) identifying, inventorying and protecting the assets in your estate at your death; (ii) paying allowable claims against your estate and administrative expenses; (iii) preparing and filing any applicable tax returns; and (iv) distributing the remaining assets to your beneficiaries or to your Trust. Please list the successor Executor after your spouse applicable. First Successor Executor

First Name

Last Name

Second Successor Executor

First Name

Last Name

Financial POA (If Applicable)

The Agent named in your Financial Power of Attorney is the person you authorize to manage your financial, property and business affairs on your behalf in the event of your incapacity. Your Agent may also be involved in making gifts of your property to specified individuals. Please list your successor Financial Agent(s), after your spouse if applicable. First Successor Agent

First Name

Last Name

Second Successor Agent

First Name

Last Name

Healthcare POA (If Applicable)

The Agent named in your Advance Directive is the person you authorize to make health care decisions on your behalf in the event you are unable to do so. Please list your successor Healthcare Agent(s), after your spouse if applicable. First Successor Agent

First Name

Last Name

Second Successor Agent:

First Name

Last Name

Guardians

The Guardian and Conservator, respectively, are the person or persons appointed by you to (i) physically care for and have custody over your minor children and (ii) manage the property and financial affairs of said children, in the event such appointment becomes necessary. Leave blank if not applicable. First Guardian Nomination (list both names of couple if desired):

First Name

Last Name

First Name

Last Name

Second Successor Guardian (list both names of couple if desired):

First Name

Last Name

First Name

Last Name