WILL PREPARATION QUESTIONNAIRE

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1 WILL PREPARATION QUESTIONNAIRE LAW OFFICE OF JOHN A. GIACOBBE, LLC 1 Icard lane New Rochelle, NY TEL: (914) FAX: (914) P a g e

2 I. - - EXISTING DOCUMENTS Have you executed a Will? Yes [ ] No [ ] - Have you executed a Power of Attorney? Yes [ ] No [ ] - Have you executed a Health Care Proxy? Yes [ ] No [ ] - Have you executed a Living Will? Yes [ ] No [ ] If you have answered yes to any of the above questions, please provide our office with a copy of said document. II. GENERAL INFORMATION YOUR INFORMATION 1. Your Full Name (including aliases): 2. Your Address: 3. Your Telephone Numbers: a. Home: b. Work: c. Cell: 4. Your Address: 5. Your Date of Birth: 6. Your Occupation: 2 P a g e

3 YOUR SPOUSE / PARTNER S INFORMATION 1. Your Spouse / Partner s Full Name (including aliases): 2. Your Spouse / Partner s Address: 3. Your Spouse / Partner s Telephone Numbers: a. Home: b. Work: c. Cell: 4. Your Spouse / Partner s Address: 5. Your Spouse / Partner s Date of Birth: 6. Your Spouse / Partner s Occupation: MARITAL INFORMATION 1. Are you married? Yes [ ] No [ ] 2. Have you ever been married? Yes [ ] No [ ] 3. Are you divorced? Yes [ ] No [ ] 4. Are you a widow(er)? Yes [ ] No [ ] 5. Have you had a civil partnership dissolved? Yes [ ] No [ ] 6. Do you have a pre-marital (prenuptial) agreement with your Spouse / Partner? Yes [ ] No [ ] CHILDREN 1. Please list all of your children. If they are deceased or disabled, please indicate. Name Date of Birth? 3 P a g e

4 GRANDCHILDREN 1. Please list all of your grandchildren. If they are deceased or disabled, please indicate. Name Date of Birth? DEPENDENTS, OTHER THAN CHILDREN (Spouse, Former Spouse, Civil Partner, Former Civil Partner, Co-Habitee, Elderly, Friend, Relative, etc.) 1. Do you have any dependents other than children? Yes [ ] No [ ] 2. Are there any that you do not intend to provide for in this Will? Yes [ ] No [ ] If so, please state their name: GUARDIANS FOR CHILDREN UNDER 18 YEARS OF AGE A guardian is someone who will be responsible for bringing up your child or children. Please specify two people who you would like to be the guardians of your child or children. Please specify your relationship to you, if any. Guardian Number 1: 1. Guardian Number 1 s Full Name (including aliases): 2. Guardian Number 1 s Address: 3. Your Relationship to Guardian Number 1, if any: 4. Guardian Number 1 s Occupation: 4 P a g e

5 Guardian Number 2: 1. Guardian Number 2 s Full Name (including aliases): 2. Guardian Number 2 s Address: 3. Your Relationship to Guardian Number 2, if any: 4. Guardian Number 1 s Occupation: DOMICILE / RESIDENCY 1. Where are you a resident for income tax purposes? 2. Are you a United States Citizen? Yes [ ] No [ ] 3. Where do you intend to retire? QUESTIONS, COMMENTS, NOTES 5 P a g e

6 III. EXECUTOR(S) Your Executors will be responsible for collecting and securing your assets, paying your debts, funeral expenses, bills, and any tax obligations your estate may face. Also, they will distribute your estate in accordance with the terms of your Will. Generally, a husband and wife or civil partners will usually appoint each other. On the death of the survivor of them, they usually appoint one or two other persons. Your children, if any, may act as an Executor. If you name more than one executor, you can have them act together or alone; however, under New York law, the default rule is that they must act together. A Contingent Executor takes the place of an Executor who is either predeceased, dies while serving as your Executor, or fails to qualify as your Executor. Executor: 1. Executor s Full Name (including aliases): 2. Executor s Address: 3. Your Relationship to Executor Number 1, if any: 4. Executor Number 1 s Occupation: Co-Executor: Would you like for your Executor to work together with a Co-Executor? Yes [ ] No [ ] 1. Co-Executor s Full Name (including aliases): 2. Co-Executor s Address: 3. Your Relationship to your Co-Executor, if any: 4. Co-Executor s Occupation: 6 P a g e

7 Contingent Executor: Please specify who you would like to serve as your contingent Executor should your Executor(s) predecease you or fail to qualify as your Executor(s). 1. Contingent Executor s Full Name (including aliases): 2. Contingent Executor s Address: 3. Your Relationship to Contingent Executor s, if any: 4. Contingent Executor s Occupation: Executor s Compensation and Bonding: 1. Is your Executor(s) to receive a fee for serving as your Executor? Yes [ ] No [ ] 2. Is your Executor(s) to be bonded? Yes [ ] No [ ] QUESTIONS, COMMENTS, NOTES 7 P a g e

8 IV. SPECIFIC ISSUES DO ANY OF THE FOLLOWING AFFECT YOU? 1. Is your Estate worth more than one million ($1,000,000) dollars? Yes [ ] No [ ] 2. Is your Estate worth more than five million ($5,000,000) dollars? Yes [ ] No [ ] PLEASE NOTE that is possible for your Estate to be subject to Inheritance tax on Your death and the amount of such tax charged against your Estate will depend on the nature of the provisions contained in your Will. Inheritance and Estate Tax advice and planning is not a part of the simple Will drafting service. If your Estate may become subject to Inheritance or Estate Tax, you are encouraged to engage us in a comprehensive Will drafting service. We will advise you on the likely Inheritance Tax consequences of the provisions of your Will based upon the information you have provided us with; however, we will not do so as part of our standard Will drafting service. If you ask us to do so, we will provide such advice at an additional fee. GIFTS TO CHILDREN OR GRANDCHILDREN 1. Do you wish to disinherit (or limit gifts to) a child or grandchild? Yes [ ] No [ ] 2. Do you want to plan for the special needs of a child or a grandchild? Yes [ ] No [ ] 3. Are you concerned about child or a grandchild s finances? Yes [ ] No [ ] 4. Are any of your children from a previous marriage? Yes [ ] No [ ] 5. Are any of your children or grandchildren adopted? Yes [ ] No [ ] 6. Are any of your children or grandchildren a stepchild? Yes [ ] No [ ] WIDO(ER) / CIVIL PARTNERS 1. When did your spouse die? 2. Did you inherit the whole of your spouse/partners estate? Yes [ ] No [ ] QUESTIONS, COMMENTS, NOTES 8 P a g e

9 V. BEQUESTS (Division of Property Under Your Will) SPOUSE 1. Do you plan to leave all of your Estate to your Spouse? Yes [ ] No [ ] 2. If your Spouse is deceased at the time of your death, do you want to: Yes [ ] No [ ] a. Leave everything to you children? Yes [ ] No [ ] i. In equal shares? Yes [ ] No [ ] ii. In some other manor? Yes [ ] No [ ] CHILDREN 1. Do you plan to leave all or part of your Estate to your child or children? Yes [ ] No [ ] i. In equal shares? Yes [ ] No [ ] ii. In some other manor? Yes [ ] No [ ] 2. If a Child is predeceased at the time of your death, do you want to leave their share to their child or children? Yes [ ] No [ ] FRIENDS i. In equal shares? Yes [ ] No [ ] ii. In some other manor? Yes [ ] No [ ] 1. Do you plan to leave all or part of your Estate to a friend? Yes [ ] No [ ] 9 P a g e

10 SPECIFIC PROPERTY BEQUESTS (i.e. jewelry, property, heirloom) 1. Do you plan to leave something specific to someone in your Will? Yes [ ] No [ ] LEGATEES (Bequest of a Specific Amount of Money) 1. Do you plan to leave a specific amount of money to someone in your Will? Yes [ ] No [ ] CHARITY 1. Do you plan to leave all or part of your Estate to a friend? Yes [ ] No [ ] RESIDUARY (The Remainder of Your Restate after All Other Bequests are Made) 1. Who do you plan to leave the rest of your Estate to? a. 2. Who do you plan to leave the rest of your Estate to if the party listed above is predeceased at the time of your passing? a. DO YOU WISH TO LEAVE SOMETHING TO SOMEONE WHO IS MENTALLY IMPAIRED? 1. Please state their name(s) and date of birth: Name Date of Birth Nature of Disability 10 P a g e

11 VI. INVENTORY OF YOUR ASSETS BANK ACCOUNTS Bank Account Number 1: b. Banking Institution: c. Account Title: Bank Account Number 2: b. Banking Institution: c. Account Title: Bank Account Number 3: b. Banking Institution: c. Account Title: REAL ESTATE 1. Do you own a real estate? Yes [ ] No [ ] Premises Number 1: a. Premises Address: b. Title in the name of: c. Ownership Interest: d. Lien(s) / Mortgage(s): Premises Number 2: a. Premises Address: b. Title in the name of: c. Ownership Interest: d. Lien(s) / Mortgage(s): PENSION, IRA, 401K, OTHER RETIREMENT ACCOUNTS Investment Account Number 1: b. Holding Company/Fund: Investment Account Number 2: b. Holding Company/Fund: Investment Account Number 3: b. Holding Company/Fund: 11 P a g e

12 INVESTMENT ACCOUNTS Investment Account Number 1: b. Holding Company/Fund: c. Account Title: Investment Account Number 2: b. Holding Company/Fund: c. Account Title: Investment Account Number 3: b. Holding Company/Fund: c. Account Title: LIFE INSURANCE 1. Do you have Life Insurance? Yes [ ] No [ ] Policy Number 1: a. Policy Amount: b. Insurance Company: c. Owner: d. Beneficiary: Policy Number 2: a. Policy Amount: b. Insurance Company: c. Owner: d. Beneficiary: BUSINESS INTEREST 1. Do you own a business in whole or in part? Yes [ ] No [ ] If so, please state the name of the business, your percentage of ownership, and the nature of the business: INTEREST IN A TRUST 1. Do you have an interest in a trust? Yes [ ] No [ ] If so, please state the name of the trust and your interest in the trust. Please provide our office with a copy of the trust: 12 P a g e

13 OTHER ASSETS (i.e. antiques, cars, boats, planes) 1. Do you have assets other than those mentioned above? Yes [ ] No [ ] Other Assets Number 1: a. Type of Asset: b. Value of Asset: c. Interest in Asset: Other Assets Number 2: a. Type of Asset: b. Value of Asset: c. Interest in Asset: Other Assets Number 3: a. Type of Asset: b. Value of Asset: c. Interest in Asset: CHOSE IN ACTIONS (i.e. Are you the Plaintiff in a lawsuit?) 1. Are you the Plaintiff in a lawsuit? Yes [ ] No [ ] d. Type of Lawsuit: e. Anticipated Recovery: f. Caption of the Case: g. State of Action: h. Index / File Number: SITUS (LOCATION) OF PROPERTY 1. Is the property covered by your Will in the: a. United States? Yes [ ] No [ ] b. A state other than New York? Yes [ ] No [ ] c. International? Yes [ ] No [ ] PLEASE NOTE that your Will may not effectively pass the property you own, if any, outside of the United States of America. We do not offer advice on foreign assets. QUESTIONS, COMMENTS, NOTES 13 P a g e

14 VII. DEBTS 1. Do you have any debts? Yes [ ] No [ ] Debt Number 1: a. Type of Debt: b. Amount of Debt: c. Interest in Debt: d. Collateral for Debt: Debt Number 2: a. Type of Debt: b. Amount of Debt: c. Interest in Debt: d. Collateral for Debt: Debt Number 3: a. Type of Debt: b. Amount of Debt: c. Interest in Debt: d. Collateral for Debt: QUESTIONS, COMMENTS, NOTES 14 P a g e

15 VERIFICATION OF INFORMATION I have provided answers to the information requested herein to the best of my ability. Based on the information I have provided, please prepare a Will for me. Signed: Dated: 15 P a g e

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