Kurt R. Ward - Attorney at Law, LLC

Estate Planning Questionnaire

Full Name: First Middle Last
Commonly Known As: First Last
Email: Email
Date of Birth: / MM / DD YYYY
Home Phone: - (###) - ### ####
Cell Phone: - (###) - ### ####
Address:

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Current Marital Status

Single Seperated Divorced Widow Married

Immediate Family

Provide the name and birthdate of your immediate family:

Spouse's Full Name:
Birthday:
Children's Full Name:
Birthday:
Children's Full Name:
Birthday:
Children's Full Name:
Birthday:

Current Estate Planning Documents

Indicate which estate planning documents you have in place

Living Will? Yes No
Health Care POA? Yes No
Property POA? Yes No
Last Will & Test.? Yes No

Your Decision-Makers

Provide the full name of those to be your

Health Care Power of Attorney:
(1)

(2)

(3)
Property Power of Attorney:
(1)

(2)

(3)
Executor of Last Will & Test.:
(1)

(2)

(3)
Guardian of Minor Children:
(1)

(2)

(3)

Additional Information

Feel free to add any additional information you may feel useful.