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Estate Planning Questionnaire

Thank you for choosing The Law Office of Tammy Wendt. This questionnaire is designed to help our legal team understand your unique needs and tailor our legal services to best support you. All your answers are strictly confidential.

First name

Last name

For couples making reciprocal Wills/POA's, please list your spouse's full name here and note whether all of your answers are the same or reciprocal to everything asked on this form

Phone

Address, City, State, Zip

Executor name and address (this is the person who distributes your estate after you pass)

Successor Executor(s) and address(es) (this is if the Executor, above, cannot or will not act). Name as First Alternate, Second Alternate, and their respective addresses.

Who do you want your estate to pass to after all bills are paid? And in what share? (full names and addresses) Use percentages or a dollar amounts

If the person(s) named in the preceding question predeceases you, who do you want your estate to pass to and in what share?

If you're passing your estate to your children, do you want "per stirpes" (if your child passes before you, that child's share goes to their children), or "per capita" (if your child passes before you, that childs share goes to your other living children)

Per Stirpes

Per Capita

Do you own your own home, if so, whose names are on the deed, what is the address and who do you want the home to pass to upon your death?

Do you own any property besides your home? If so, list here

Do you have any specific bequests? If so, name them here

Do you have any specific exclusions? (any person(s) you would like to specifically exclude from inheriting under your Will) If you are excluding a child or spouse who would be legally entitled to inherit if you did not have a Will, you must name them here

Please list all of your assets here (approximation), this includes 401(k), IRA, stocks, bonds, cash

Name, address and phone for the agent you choose to make your healthcare decisions for you (healthcare power of attorney)

Successor Agent name, address and phone

Name, address and phone for the agent you choose to make your property and financial decisions for you (property power of attorney)

Successor Agent name, address and phone

When do you want the powers of attorney to become effective?

Immediately

When my doctor determines I am no longer able to make decisions for myself.

Choose 1 of the below with regard to your end of life wishes (your Living Will/Advance Directive)

The quality of my life is more important that the length of my life. If I am unconscious and my doctor believes I will not wake, think or communicate, I do not want treatments to prolong my life or delay my death, but I do want treatment to be pain free and comfortable.

Staying alive is more important to me, no matter how sick I am, how much I am suffering, the cost of the procedures, or how unlikely my chances for recovery are. I want my life to be prolonged to the greatest extent possible in accordance with reasonable medical standards.

With regard to donating organs, please choose one of the three below

I authorize my agent to donate any organs, tissues or eyes suitable for transplantation or for research or educational use

I authorize my agent to donate specific organs, listed below

I do not authorize or grant my agent authority to make anatomical gifts.

List of specific organs authorized for donation

If you wish to limit the scope of your agents' powers or prescribe special rules or limit the power to authorize autopsy or dispose of remains, please state here

Please list any questions or concerns you have in the area below.