Your Name
*
First Name
Last Name
If you have minor children, which individuals would you trust to take care of your minor children, if you can’t care for them or are deceased? N/A
Who should oversee and manage the money you’ve left your children until they reach the designated age? N/A
How old should your minor children be before they handle money you’ve left them, if you’re deceased? (The money can be accessed by your trustee for your children’s needs until they take over at the designated age.)
Which individuals would you trust to handle your finances should you become disabled?
If you are married and become incapacitated, will your spouse always serve in the first position to make your decisions?
*
Yes
No
Still Unsure
Which individuals would be best to speak to your doctors and handle your major medical decisions?
Which individuals would handle your estate and pay your final bills and expenses at your death?
Do you wish to be kept alive by artificial means if you can no longer communicate and a licensed physician deems that you are at the end stage of a disease which will take your life within a short period of time?
Yes
No
Still not sure
Do you want your health care agents to consult with the doctor before a final decision is made regarding your end of life care?
*
Yes
No
Still not sure
Which do you prefer?
*
Buried
Cremated
Do you wish to be an organ donor?
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Yes
No
Still not sure
Your estate (life insurance, IRA’s, 401ks, real estate, bank accounts, business interests, etc.)
*
Less than $500,000
More than $500,000
Use the space below to name the people who will receive something from you when you die AND what each person will receive. Use percentages.
