SINGLE - WILL - TRUST

CONFIDENTIAL INFORMATION

Date of 1st Consultation: Signing Date:

Client will keep COPY of Will Client will keep ORIGINAL of Will

FIRST NAME

Middle Name

LAST NAME

ADDRESS

County

HOME PHONE #

CELL PHONE #

E-MAIL ADDRESS

SS #

Names of Children and marital status:

Successor Trustee

2nd Successor Trustee

Personal Representative

Successor Personal Representative

Durable Power of Attorney

Successor Durable Power of Attorney

Health Care Surrogate

Name Relationship:

Address

Phone #

Successor Health Care Surrogate(s)

Name Relationship:

Address

Phone #

Name Relationship:

Address

Phone #

Living Will

If Minor Children - Legal Guardian

Successor Guardian

Birthday

DISTRIBUTION

NOTES

Referred By: