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Use this form to make your will.

• It will help you not to forget any one or anything.
• You can print it out and fill it in.

This form is very long. But, you only need to fill in the parts that are right for you. For instance,

• if you don't own land, don't fill in the part about real estate
• if you don't have children, don't fill in the part on children or grandchildren
• if you hire a lawyer to write your will, this sheet will help your lawyer

 

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Personal Information

1.               Full Name: _______________________________________________________

     (first)          (middle)          (last)

Address:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2.   Do you use any other name or nickname on any bank accounts, deeds, bonds,

or stocks etc.?           Yes     No

3.               If yes, what other name(s) do you use?

_______________________________________________________

(first)        (middle)       (last)

_______________________________________________________

     (first)        (middle)       (last)

4.   Do you consider this State to be your home?    Yes  No

5.     Relatives

           (a)        Spouse (If you have had more than one spouse, please provide information for each spouse on a separate sheet of paper)

Spouse Name______________________________________________________________________

                     (first)        (middle)       (last)

Address _____________________________________________________________________ 

When married? _______________________________________________________________

Where were you married? _____________________________________________________

Is Your Spouse Alive?       Yes     No

           (b)  Children (list all- please include information for additional children on a separate sheet of paper)

Name/Address                   Under 18?       Alive?    Name of Other Parent

1.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

2.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

3.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

4.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

5.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

6.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

(c)           Grandchildren (list all- please include information for additional grandchildren on a separate sheet of paper)

Name/Address                   Under 18?       Alive?    Name of Other Parent

1.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

2.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

3.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

4.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

5.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

6.      _____________________          Yes      No        Yes     No     _____________________

     _____________________

     _____________________

(d)           Brothers and Sisters (list all- please include information for additional siblings on a separate sheet of paper)

Name/Address                                    Alive?

1.     ______________________                    Yes      No
     ______________________                   
     ______________________

2.     ______________________                    Yes      No
     ______________________                   
     ______________________

3.     ______________________                    Yes      No
     ______________________                   
     ______________________

4.     ______________________                    Yes      No
     ______________________                   
     ______________________                   

5.     ______________________                    Yes      No
     ______________________                   
     ______________________

6.     ______________________                    Yes      No
     ______________________                   
     ______________________   

(e)           Parents Alive?

1.     ______________________                    Yes      No
     ______________________                   
     ______________________

2.     ______________________                    Yes      No
     ______________________                   
     ______________________

6.               Have you ever made prior wills?               Yes      No

If so, how many times and when? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7.               If so, for each such will, indicate on a separate sheet of paper the following:

                                                         i.      when the Will was made:

                                                     ii.      was it revoked?  If so, how and when?

      If so, how and when?

iii.     where are the prior wills now?

8.   Do you have any directions concerning your funeral or buria1

or interment?      Yes      No

     If so, give directions:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9.               Maximum amount to be spent on funeral, if any.

______________________________________________________________________________________________________________________________________________________________

10.              Taxes

   Who should pay inheritance taxes? (Check one)

_____ Each recipient of property pays own share of taxes

_____Estate pays all taxes

_____Other (please describe): _________________________________________________________________________________

11.  Real Estate (please include information about additional pieces of real estate on a separate sheet of paper)

Approx. Value      Amount of

Location (street,     Today (Tax as‑        Remaining      Other names

county, state)          sessed value)        Mortgage       on Deed

a.______________          _______________      ______________     ____________________

  ______________

  ______________

b.______________          _______________      ______________     ____________________

  ______________

  ______________

c.______________          _______________      ______________     ____________________

  ______________

  ______________

12.       Bank Accounts

                Single,

Checking        Joint or                    Estimated

or Savings        in‑Trust        Other Names     Present

Names of Bank      Account?       Account?       on Account      Balance

__________________     ____________     ______________     _____________     __________

__________________     _____________     ______________     ______________     __________

__________________     _____________     ______________     ______________     __________

__________________     _____________     ______________     ______________     __________

13.     Stocks (please include information about other stocks on an additional piece of paper)

Number     Approximate     Names of

of          Market Value      Co‑Owner

Name of Company              Shares    of One Share     of Stock

________________________     _________     ______________     __________________________
________________________     _________     ______________     __________________________
________________________     _________     ______________     __________________________
________________________     _________     ______________     __________________________
________________________     _________     ______________     __________________________

If the stock is reissued in another corporation's name due to a merger, do you want stock in successor corporation to go to the same person?

Yes     No

14.  Bonds

Name of Company

Or Type of Bond

(Series E, H, etc.)             Amount               Name(s) of Bond Co-Owner

_____________________________     _________________     ___________________________

_____________________________     ___________________     ___________________________

_____________________________     ___________________     ___________________________

_____________________________     ___________________     ___________________________

_____________________________     ___________________     ___________________________

_____________________________     ___________________     ___________________________

15.     Business Interest

Do you have an ownership interest in any business?

     Yes     No

          If yes, give details on separate sheet of paper

16.  Debts (owed to you by another-please provide information about additional debtors on a separate sheet of paper)

Name of Debtor                                Amount Owed

_________________________________________     ___________________

_________________________________________     ___________________

_________________________________________     ___________________

_________________________________________     ___________________

_________________________________________     ___________________

_________________________________________     ___________________

17.     Vehicles (car, boat, mobile home, etc.- please provide information about additional vehicles on an additional piece of paper)

            Approximate Name(s) of

Description of Item  Market Value Co‑Owners of Vehicle

1.     ________________________     ______________     ______________________
2.     ________________________     ______________     ______________________
3.     ________________________     ______________     ______________________

4.     ________________________     ______________     ______________________

18.     Business Benefits

Do you have any business benefits (pension plan, profit sharing fund, deferred compensation plan, stock option)?

Yes     No

If yes, describe (continue additional pieces of paper if necessary)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

19.  Life Insurance (on your life)

Name Of Company             Amount of Insurance         Designated Beneficiary

_____________________________            ____________________________            ____________________________

_____________________________            ____________________________            ____________________________

_____________________________            ____________________________            ____________________________

_____________________________            ____________________________            ____________________________

20.  Are you a beneficiary    of anyone else's life I insurance

     policy? 

Yes     No

          If yes, what is the:

Name of other Person                     Amount of Insurance

__________________________________     ____________________

__________________________________     ____________________

__________________________________     ____________________

__________________________________     ____________________

21.  Your Debts (what you owe to others-please include information about additional debts on another piece of paper)

To Whom is Debt Owed (Name)                       Amount

_____________________________________________     ________________
_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

_____________________________________________     ________________

22.  Gifts

(a)  Have you I or your spouse made any gifts of valuable

     items in the last three years?

          Yes     No

     If yes please list below (please provide information on additional gifts on a separate piece of paper)

Name of Recipient     Date Given      Describe Gift      Value

____________________     _____________     ______________     ___________
____________________     _____________     ______________     ___________
____________________     _____________     ______________     ___________
____________________     _____________     ______________     ___________
____________________     _____________     ______________     ___________

23.     Inheritance

Do you anticipate any inheritance? Yes      No

If so, describe the nature and approximate value

Nature                                                Approximate Value

___________________________________________________     _________________
___________________________________________________     _________________
___________________________________________________     _________________
___________________________________________________     _________________
___________________________________________________     _________________

24.  Your Plan for Disposition of Assets

(a)     Tangible Personal Property (such as car, jewelry, art, etc. - please provide information on additional property on a separate piece of paper)

                                Alternate

Item            Recipient(s)        Recipient(s)     Comments*

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________

(b)     All Other Property (such as savings, stock, "bonds, real estate, etc. - please provide information on additional property on a separate piece of paper)

Item            Recipient(s)        Recipient(s)     Comments*

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________

(c)           Residuary Estate(all property not covered

Above - please provide information on additional property on a separate piece of paper)

Portion         Recipient(s)        Recipient(s)     Comments*

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________

______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________
______________     ______________     _______________     _______________________

25. Debts You Wish to Forgive

Do you wish to forgive any debts owed to you at the time of your death?

     Yes  No

If yes, which ones?

Name of Debtor          Amount of Debt       Conditions*

___________________     __________________     _____________________________
___________________     __________________     _____________________________
___________________     __________________     _____________________________
___________________     __________________     _____________________________
___________________     __________________     _____________________________
___________________     __________________     _____________________________

*Include any conditions or limitations on the receipt of any items including who shall pay for packing and transportation and insurance.

26.           If you own real estate, do you want the real estate to pass subject to all

mortgages, liens and encumbrances? (This that you ever you leave the real estate to will have to pay the any mortgages, liens or encumbrances)

     Yes   No

          If no, do you want the estate to     pay off all mortgages,

          liens and encumbrances? Yes      No

27.  Do you want all jointly owned property (bank accounts,

     stocks, bonds, real estate, cars) to go to joint owner?

          Yes     No

                If no, explain?

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

28. Who shall pay expenses (taxes, utilities, etc.) of your real property (if any) while estate is being administered? Check one:

_______the Estate

_______the Recipient

Administration

     (a) Executor/Executrix

(1)  Name and address of your personal representative (the person to handle your estate)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)           Name and address of alternate personal representative if first preference           should die or can't do it

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)    Do you wish to waive bond? (waiving bond means that your personal representative is does not have to put down a deposit of money to cover the cost any mistakes they might make.  The bond also protects their estate is you commit fraud.)  If you waive bond, they do not have to put down a deposit. Do you wish to waive bond?       

Yes              No

(4)  Do you wish the personal representative to be paid?     Yes  No

 If yes, how much?______________________________________________

(5)  Do you want any gifts you may have made to your personal representative to be his/her only payment for serving as the person who settles your estate?

     Yes ­No

     If yes, which gifts?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(b) What powers do you wish for the personal representative to have? (Check desired powers):

­­­­_____ Sell property on whatever terms s/he decides

_____ Rent     property on whatever terms s/he decides.

_____     Repair property.

_____     Convert all property to cash and place in checking account.

_____     Excused from having to invest property.

_____     Change location of property (including out‑of‑state).

_____     Borrow money

_____     Settle claims of creditors/debtors on whatever terms s/he decides.

_____     Decide what property shall be part of each person's share

_____     Exercise all rights of stock ownership.

_____     Employ attorney and other professional help

_____ Enter into transactions with other fiduciaries including himself/herself.

Guardian

Do you have custody of a minor child who will require a guardian upon your death?    

Yes     No  

If so, who do you want to serve as guardian?

Name:_______________________________________________________________

(a)     Are any recipients of your property minors?

                Yes     No  

      If yes, list their names and ages:

Name                                                  Age

__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________
__________________________________________________     _______________

(b)           Should the property be given to the minor's parents (or custodian) or

placed in trust? Explain:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(c)           If property is to be given to a class of children (i.e., all children

or grandchildren), do you want to include adopted or illegitimate children?

     Yes      No­