Individual - Pierce Legal Group

Contact Information

Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Personal Information

Address(Required)

Street Address City State Zip Code

Gender

Marital Status(Required)

Spouse Name

First Middle Last

Address

Spouse address different from yours

Spouse Address

Street Address Address Line 2 City State Zip Code

Are you a US Citizen?(Required)

What is the approximate value of your combined estate?(Required)

Family Information

Do you have Children?

How many Children do you have?

Child 1 Name

First Middle Last

Address 1

Different from yours

Child 1 Address

Street Address City State / Province / Region ZIP / Postal Code

Child 1

Under 18

Adopted

Child 2 Name

First Middle Last

Address 2

Different from yours

Child 2 Address

Street Address City State / Province / Region ZIP / Postal Code

Child 2

Under 18

Adopted

Child 3 Name

First Middle Last

Address 3

Different from yours

Child 3 Address

Street Address City State / Province / Region ZIP / Postal Code

Child 3

Under 18

Adopted

Child 4 Name

First Middle Last

Address 4

Different from yours

Child 4 Address

Street Address City State / Province / Region ZIP / Postal Code

Child 4

Under 18

Adopted

Do you have Stepchildren?

How many Stepchildren do you have?

Stepchild 1 Name

First Middle Last

Stepchild Address 1

Different from yours

Stepchild 1 Address

Street Address City State / Province / Region ZIP / Postal Code

Stepchild 1

Under 18

Adopted

Stepchild 2 Name

First Middle Last

Stepchild Address 2

Different from yours

Stepchild 2 Address

Street Address City State / Province / Region ZIP / Postal Code

Stepchild 2

Under 18

Adopted

Stepchild 3 Name

First Middle Last

Stepchild Address 3

Different from yours

Stepchild 3 Address

Street Address City State / Province / Region ZIP / Postal Code

Stepchild 3

Under 18

Adopted

Stepchild 4 Name

First Middle Last

Stepchild Address 4

Different from yours

Stepchild 4 Address

Street Address City State / Province / Region ZIP / Postal Code

Stepchild 4

Under 18

Adopted

Are any of your Children deceased?

How many deceased children?

Deceased Child 1 Name

First Middle Last

Deceased Child 1

Survived by Child/Children

Deceased Child 2 Name

First Middle Last

Deceased Child 2

Survived by Child/Children

Deceased Child 3 Name

First Middle Last

Deceased Child 3

Survived by Child/Children

Deceased Child 4 Name

First Middle Last

Deceased Child 4

Survived by Child/Children

Would you like to choose a guardian for your minor Child/ Children?

Guardian Name

First Last

Guardian Address

Street Address City State / Province / Region ZIP / Postal Code Country

Would you like to choose an alternate guardian for your minor Child/ Children?

Alternate Guardian Name

First Last

Alternate Guardian Address

Street Address City State / Province / Region ZIP / Postal Code Country

Your Will

The questions in this section will help us create your Will. If you do not know the answers to any of the questions, please skip them. If you would like us to explain the questions, please contact us during normal business hours. An associate from our firm will be glad to assist you.

Number of Executors / Personal Representatives you would like to choose?

A personal representative (also known as an executor or administrator) is the person or entity who oversees your estate upon your death. They are responsible for paying your debts and the distribution of your remaining assets according to the terms of your will.

Executor/Representative 1 Name

First Last

Executor/Representative 1 Address

Street Address City State ZIP Code

Executor/Representative 2 Name

First Last

Executor/Representative 2 Address

Street Address City State ZIP Code

Would you like your Executors / Personal Representatives to be compensated according to Ohio statutes?

Do you have a preference regarding cremation?

Do you want your Executors / Personal Representatives to handle your burial and funeral?

Who would you like to handle your burial and funeral?

First Last

Do you have any specific instructions for your burial and funeral?

Distribution of your Estate

Specific Distributions

You have the option to leave specific and charitable gifts to a beneficiary, group of beneficiaries or to a charity prior to distributing your entire residual estate. These gifts are distributed after your executor pays the final debts of your estate and before your executor distributes the residual estate. The balance of your estate after paying debts, specific and charitable gifts is distributed to the person/persons you name as residual beneficiaries.

Would you like to make a Charitable Gift?

How many Charitable Gifts would you like to make?

Name of Charity 1

Charity 1 Address

Street Address City State ZIP Code

Charity 1 Description of Gift

Name of Charity 2

Charity 2 Address

Street Address City State ZIP Code

Charity 2 Description of Gift

Would you like to leave a monetary gift to an Individual?

How many monetary gifts would you like to leave?

Individual 1 Name

First Last

Individual 1 Amount

Individual 2 Name

First Last

Individual 2 Amount

Would you like to leave a monetary gift to a class of beneficiaries?

Examples of a class of beneficiaries are grandchildren, great grandchildren and siblings. Your bequest could be a direct that the sum of $10,000.00 shall be distributed to my grandchildren.

How many class monetary gifts would you like to leave?

Class 1

Class 1 Amount

Class 2

Class 2 Amount

Would you like to give a gift of real estate to a beneficiary?

How many Real Estate Gifts would you like to give?

Real Estate Beneficiary 1 Name

First Last

Real Estate 1 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Your Primary Residence

Real Estate Beneficiary 2 Name

First Last

Real Estate 2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Your Primary Residence

Would they like to give a specific bequest? (An item of personal significance for example)

Please describe the specific bequest

RESIDUAL DISTRIBUTION

The questions below will help us determine how you would like your residual estate to be distributed.

How would you like your estate to be distributed?

How many beneficiaries would you like to have?

Beneficiary 1 Name

First Last

Beneficiary 1 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Beneficiary 1 Relationship

Beneficiary 1 Percentage

Beneficiary 1 Distribute

Please explain

Beneficiary 2 Name

First Last

Beneficiary 2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Beneficiary 2 Relationship

Beneficiary 2 Percentage

Beneficiary 2 Distribute

Please explain

Would you like to specifically exclude a person or group of people from receiving a portion of your estate?

If you would like to add distribution instructions or if you have any questions regarding the distribution of your estate, please comment below and the attorney will speak to you regarding the same.

If a beneficiary is deceased, would you like the distribution to go to the deceased beneficiaries’ descendants or lapse (go to the other beneficiary(ies)?

Are any of your beneficiaries disabled?

It is important for us to know if any of your beneficiaries are disabled because an inheritance could limit or extinguish state benefits. By creating a special needs trust your disabled beneficiary will not lose his or her benefits and can receive benefits for items not covered by state benefits.

How many disabled beneficiaries do you have?

Disabled Beneficiary 1 Name

First Last

Disabled Beneficiary 2 Name

First Last

Durable Power of Attorney/Health Care Power of Attorney

Durable Power of Attorney

This section will provide us with information for your Durable Power of Attorney and Health Care Power of Attorney with optional New Jersey Advance Health Care Directive If you do not know the answers to any of the questions, please skip them. If you would like us to explain the questions, please contact us during normal business hours. An associate from our firm will be glad to assist you.

Agents/Representatives

Different from previous Agents/Executors/Representatives

How many agents would you like to choose?

It is recommended that you choose an alternate Agent. This will avoid problems in the event that the person you choose cannot perform his or her duties. Would you like to choose a backup?

How would you like your Agents to act?

Would you like all of the Agents named to act Jointly?

Please explain

Agent 1 Name

First Last

Agent 1 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Agent 2 Name

First Last

Agent 2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Health Care Power of Attorney

Health Care Representatives

Different from previous Agents/Executors/Representatives

Number of Health Care Representatives you would you like to choose?

It is recommended that you choose an alternate Agent. This will avoid problems in the event that the person you choose cannot perform his or her duties. Would you like to choose a backup?

How would you like your Agents to act?

Would you like all of the Agents named to act Jointly?

Please explain

Agent 1 Name

First Last

Agent 1 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Agent 2 Name

First Last

Agent 2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Additional Information which may not have been previously addressed.

Additional Information or Extenuating Circumstances

Phone

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