Name:

Date:

(please read the linked pages before filling out this document. Do not hesitate to contact this office if you have any questions regarding the requested information)

Linked Pages:

• What You Should Know About Wills
• What You Should Know About Guardianship, Living Wills/Health Care Proxy and Powers of Attorney

1. Testator/Testatrix("Will Maker"):

Full Name:
Street Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Business Phone:
E-Mail:
Social Security #:
Date of Birth:

2. Will Makers Spouse (if applicable):

Full Name:
Street Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Business Phone:
E-Mail:
Social Security #:
Date of Birth:

3. Children (if applicable):
(email attatchment to edamaral@amaralassociates.com, if more than 4 children)

Child #1

Full Name:
Address: (if different from above)

Date of Birth:
Social Security # :

Child #2

Full Name:
Address: (if different from above)

Date of Birth:
Social Security # :

Child #3

Full Name:
Address: (if different from above)

Date of Birth:
Social Security # :

Child #4

Full Name:
Address: (if different from above)

Date of Birth:
Social Security # :

4. Real Estate (if applicable):

Location of Property #1:

(a)Street Address:

(b)City/Town

(c)State

(d)Zip

(e) County (i.e. Suffolk):

(f) Country

Location of Property #2:

(a)Street Address:

(b)City/Town

(c)State

(d)Zip

(e) County (i.e. Suffolk):

(f) Country

5. Residuary Estate (Catch basin: if a distribution or bequest fails or lapses, your assets will go to the following):

Spouse Yes No
Children Yes No
Trust(re:children's trust) Yes No
Named Beneficiary Yes No
Heirs of Law? Yes No
Charity Yes No

6. Name of Executor or Executrix (person whom willmaker delegates responsibility for carrying out the terms of this will.) :

Spouse Yes No

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

7. Name of Alternate Executor/Executrix(in the event the above-named is unable or unwilling to serve) :

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

8.Guardian (if you have children under the age of 18, you should appoint a guardian or co-guardian to care for your children in the even that you or your spouse ( or other parent) either die or are unable to care for your children.) :

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

Relationship to Willmaker :(i.e. mother, aunt, etc.)

9. Name of Alternate Guardian:

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

Relationship to Willmaker :(i.e. mother, aunt, etc.)

10. International Exclusions: (names of person(s) or organizations that you intentionally want to exclude from recieving your assets under this will, if any.)

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

11. Health Care Proxy/Living Will:

(A) Do you have a Health Care Proxy or Living Will (i.e. documents that instruct your medical providers to withhold life support equipment while you are alive but have no hope of regaining consciousness?)

Yes No

(B) Agent - (person you would like to make sure medical care providers follow the terms of your Health Care proxy ot Living Will)

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

(C) Alternate Agent:

Full Name:

Street Address:

City, State, Zip:

Home Phone Number:

Work Phone Number:

12. Power of Attorneys: (do you have documents that appoint somebody whom you trust to manage or sell your property or business, or handle financial affairs (i.e. investments), in the even you become ill or incapacitated?)

Yes No

(A) Agent:

Full Name:

Street Address:

City, State, Zip:

Phone Number:

Relationship:

(B) Alternate Agent:

Full Name:

Street Address:

City, State, Zip:

Phone Number:

Relationship: