Husband's Information

Wife's Information

Children and/or other family members

Use full legal names, complete addresses and dates of birth. (Use “JT” if both spouses are the parents, “H” if husband is the parent and “W” if the wife is the parent.)

Trustees/Executors/Financial Agents

Your trustees/executors/financial agents will be the people who will make choices for you after your death and if you become unable to make choices for yourself. Your spouse will usually be your first successor trustee. List at least 2 additional trustees/executors/financial agents.

Health Care Agents

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?

Guardian for Minor Child(ren)

If you have any children under the age of 18, list in order preference who you wish to be guardian. It is usually wise to choose someone other than a Trustee/Executor for this responsibility.

Beneficiaries

Remote Contingent Beneficiaries

Real Property

Private or Small Business Interests

Assets

Checking and Savings Accounts

CD's and Money Market Accounts

Stocks, Bonds and Mutual Funds

Retirement Accounts

IRA, 401-K, TSA or other Accounts

Life Insurance/Annuities

Income Sources