Estate Planning Questionnaire

Your Estate Planning Questionnaire

Thank you for getting started! This questionnaire is a convenient and secure option for providing your attorney with the preliminary information needed to prepare the initial draft of your Estate Plan.
After you've submitted the form, your attorney will receive the information and begin working on your plan. A first draft is typically presented to you for review 3-5 days later.
If you have any questions or problems with the questionnaire, please fee free to contact us at 954-484-9987 or send an email to emil@fleysherlaw.com.

Your Name*

First Middle Last Suffix

Marital Status*

Your Spouse's Name*

First Last

Your Former Spouse's Name*

First Last

Your Current Address*

Enter the address of your primary residence.

Street Address Address Line 2 City State ZIP Code

Do you own or rent your primary residence?*

Own

Rent

Other

Do you own or have a legal interest in any Real Estate other than your primary residence?*

This can include investment properties, vacation homes, vacant land, etc. that you are a full or part owner of.

Yes

Other

Other Real Estate*

Please list any properties you own or have an ownership interest in. Be sure to include the address, the nature of your ownership interest, and a brief description of what the property is used for.

Your Phone Number*

Your Email Address*

Your Date of Birth*

Your Spouse's Date of Birth*

Are you the Primary Shareholder of any Corporations or the Member of any Companies or Partnerships?

If you own your own business or have a large stake in one, your interest in that business may be included in your estate plan to avoid probate and/or unnecessary expenses and litigation.

Yes

Other

Business Interests

Please describe in detail the nature of your interest in any of these businesses as well as the nature of the business itself.

Do you have any children?*

This includes natural, adopted, and fostered.

Yes

How many children do you have?*

Are any of your children currently under 18 years old?

Yes

Backup Guardian

Please provide the full name, address, phone number, email address, and date of birth of the person or persons you would like to designate as your minor's guardian in your absence.

Child 1: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Child 2: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Child 3: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Child 4: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Child 5: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Child 6: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Do you have any grandchildren?*

Yes

How many grandchildren do you have?*

Grandchild 1: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Grandchild 2: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Grandchild 3: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Grandchild 4: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Grandchild 5: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Grandchild 6: Full Name, Address, Phone Number, Email Address, and Date of Birth*

Asset & Property Distribution (Who gets what?)*

Please let your attorney know how you would like your assets and possessions distributed after you've passed away.

Who would you like to choose as your primary Trustee / Personal Representative if you were to pass away?*

Most married couples select their surviving spouse as their 1st choice but this decision is completely up to you. You're essentially choosing the person in your life you trust the most to carry out your wishes in your absence. Please provide this person's full name, address, phone number, email address, and date of birth.

Who would you like to choose as your backup Trustee / Personal Representative if you were to pass away?*

If your primary choice predeceases you or is otherwise unable or unwilling to act as your Trustee / Personal Representative, this is the next best person for the job. Please provide this person's full name, address, phone number, email address, and date of birth.

Who would you like to choose as your primary Power of Attorney (POA) if you were to become incapacitated?*

Here, you are choosing the person you trust the most to act on your behalf when it comes to financial and administrative decisions while you're still alive, but incapacitated. Please provide this person's full name, address, phone number, email address, and date of birth.

Who would you like to choose as your backup Power of Attorney if you were to become incapacitated?*

If your primary POA choice predeceases you or is otherwise unable or unwilling to act as your Attorney-in-Fact, this is the next best person for the job. Please provide this person's full name, address, phone number, email address, and date of birth.

Who would you like to choose as your primary Healthcare Surrogate if you were to become incapacitated?*

Here, you are choosing the person you trust the most to act on your behalf when it comes to your medical and physical care decisions while you're still alive, but incapacitated and unable to speak or communicate for yourself. Please provide this person's full name, address, phone number, email address, and date of birth.

Who would you like to choose as your backup Healthcare Surrogate if you were to become incapacitated?*

If your primary choice predeceases you or is otherwise unable or unwilling to act as your Healthcare Surrogate, this is the next best person for the job. Please provide this person's full name, address, phone number, email address, and date of birth.

Terminal Condition / End of Life Preference*

Is it your desire to be kept alive artificially if you become mentally and physically incapacitated, have a terminal condition, are in a persistent vegetative state, and at least 2 doctors have determined that there is no reasonable medical probability of recovery?

Yes

Not Sure

Artificial Nutrition & Hydration*

Do you desire hydration and nutrition be withheld or withdrawn when the application of such procedures would only serve to artificially prolong the process of dying.

Yes

Not Sure

Organ Donor*

Do you want your kidneys, lungs, liver and/or bone marrow donated after your death?

Yes

Not Sure

Burial/Cremation Preferences*

This is not a question anyone likes to spend a lot of time thinking about, but please let your attorney know if you have any special preferences or instructions with regard to your funeral and burial or cremation ceremony.

Congrats! You've reached the end of the questionnaire.

Please click the "Submit" button below to submit this form and data to your attorney. Your attorney will follow up with you within 3-5 business days. If you have any questions in the interim, please feel free to call or email.

Phone

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