Your Will
Get Started!
1) Full name (rst, middle, last):
All other names by which you have been known:
Membership Number:
Age: Date of Birth (DOB): Sex: Male
Are you a US citizen?* Y N If no, country of citizenship:
2) Current residence
Street address:
County or Parish: ST: ZIP:
Home Phone: Work Phone:
3) If you are married, your spouse’s full name (rst, middle, last, maiden):
DOB: Date of marriage:
Place of marriage:
Are you currently living with your present spouse? Y N
4) Do you and your spouse have a Prenuptial Agreement which identies and disposes
of separate spousal property?
If yes, attach copy with any ling data.
* Non-citizen estate taxation varies from taxation for US citizens.
Everything that you own at your
passing after payment of debts
and taxes. You will make decisions
regarding the percentage share
of your estate that you wish to
give to your beneficiaries. And if
you wish, you may leave specific
items of property (car, investments,
heirlooms, etc.) or sums of money to
your beneficiaries.
A document which provides who is
to receive your property, who will
administer your estate, who will
serve as guardian of your children, if
applicable, and other provisions.
peace of mind
The wonderful feeling you get as a
LegalShield member after having
your Will prepared by a qualified
law firm at a reasonable price.
What You’ll Need to Complete This Questionnaire:
Copy of your Prenuptial Agreement (if applicable).
Names and birth dates of your children and grandchildren
(if applicable).
The name
contact information of the person you’ve chosen to be
guardian of your child(ren), the trustee(s) of their estate, and your personal
To best serve you in completing your Will for estate tax purposes, you’ll be
asked to provide the approximate dollar amount of such items as: your home,
other real estate, bank accounts, vehicles, retirement plans, life insurance
policies, and debts such as mortgages, loans, medical or others over $5,000.
Helpful Information before You Get Started!
This Will Questionnaire is NOT your Will. It will help your Provider Law Firm
prepare your Will. All questions applicable to you MUST be completed in their
entirety in order to have your Will prepared.
If you need more space to answer a question, attach a separate sheet and
indicate the question number to which it pertains.
If you have questions while lling out this form, don’t hesitate to call your
Provider Law Firm at the number on your membership card.
If you need the number to your rm, call Member Services at 1-800-654-7757
(7 a.m. - 7 p.m., Monday-Friday, Central Time).
p 1 of 6 • Will Questionnaire
Please print
In order to meet each persons
unique needs, you must each ll
out a Will Questionnaire.
For Your
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5) If either you or your spouse has been divorced, please answer the following.
If not applicable, please go to question #6.
Date of marriage:
Date of divorce judgment:
Court rendering judgment:
Date of spouse’s death (if applicable):
6) Have you or your spouse created any trusts or made gifts through trusts to
others? If yes, describe and include a copy. If not applicable, go to question #7.
7) Do you or your spouse expect any inheritance? If yes, state from whom and how
much. If not applicable, please go to question #8.
8) If you have children, including adopted children, state the following for each child.
If you do not have children, please go to question #15.
9) a. Deceased biological or legally adopted children if applicable.
b. Deceased child’s living children if applicable:
10) If you have stepchildren, do you want them treated the same as your natural born
or legally adopted children in your Will?
If yes, state the following for each:
If you have grandchildren, state the following for each. If not, go to question #12.
Full Name Son/Daughter Date of Death
Full Name Parent’s Name
Grandson /
A great deal of personal information is
requested in your Will Questionnaire.
Without all of the information requested,
your Provider Law Firm can’t ensure
your wishes will occur or that the most
comprehensive estate planning options
have been advised. All information
you provide them will remain strictly
For Your
Dear LegalShield,
I’m writing to thank you for your
rm’s excellent preparation of
my Last Will and Testament. [My
lawyer] has been very professional,
knowledgeable, and responsive to
my calls and questions. Due to his
excellent service, I am pleased to
continue using LegalShield and to
recommend it to friends, family, and
business associates.
Florida Member
Child of Current
Marriage? (Y/N)
Full Name Son/Daughter Date of Birth
Full Name Son/Daughter Date of Birth Parent’s Name
Full Name Male/Female Date of Birth Parent’s Name
Will Questionnaire • p 2 of 6
12) Are any of your children or other beneciaries mentally or physically disabled or
have special needs?
If so, note any special provisions:
If so, are they presently receiving, or do you anticipate that they may apply
for, SSI
benets in the future?
Note: If you leave a bequest, not left to a qualied trust, the recipient might be disqualied from SSI benets.
13) If your children are under age eighteen (18), state the following for the person you
wish to act as their guardian (custodian) in the event of your death or in case of
the joint death of you and your spouse (if married).
You should obtain the consent
of that person(s) before executing your will
If you do not have any minor children, please go to question #15.
If at the time of your death the person(s) named above is/are unwilling to serve as
guardian (custodian), please list an alternate:
14) Do you want the appointed guardian also to be the trustee (conservator) of any
assets inherited by the minor children?
At what age would you like your children to take control from the trustee of any
inherited assets?
(Must be at least 18 years old.) years old
If no, please list the person or entity you wish to act as their nancial custodian.
You should obtain the consent of that person or entity before executing your Will.
Please list an alternate in case this person is unwilling or unable to serve:
A person lawfully invested with the
power, and charged with the duty,
of taking care of the person who is
incapable of doing so because of age
or other incapacity. Certain states
do not allow anyone other than a
biological parent to be appointed as
guardian of minor children in the
event of one parents death. Please
call your Provider Law Firm for
instructions for your state.
NOTE: Louisiana residents, although the
provision in a Will providing for a guardian of
minor children is not binding in your state, it
is highly persuasive in a proceeding for the
appointment of a guardian and should be
included in the Will of any person with minor
A person appointed to manage the
financial affairs of the one who is
legally incapable of doing so because
of age or other incapacity.
joint tenants with right of
A single property owned by two
or more persons, under one title,
with equal rights to the property.
At the death of one joint tenant, the
property transfers to the surviving
Halfway Point
p 3 of 6 • Will Questionnaire
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For Your
15) Indicate how you want your assets to pass when you die.
Please check the ONE option you prefer:
I want my assets to pass to my spouse and children as follows:
To my spouse, if surviving.
If my spouse predeceases me, my assets will be divided in equal
shares to my children.
If any of my children predecease me, that child’s
share shall be
distributed to his or her children in
equal shares.
In the event my spouse and all of my children and descendents fail
to survive me, I want my assets to be distributed as follows:
I am unmarried with children and want my assets to pass as follows:
In equal shares to my children.
If one or more of my children predeceases me, that child’s share in
my estate is distributed to his or her children in equal shares.
In the event all my children and descendents fail to survive me, I
want my assets to be distributed as follows:
None of the above. I want my assets to pass as follows:
If you own property jointly with another
person as “joint tenants with right
of survivorship,” your interest in that
property will pass to the survivor upon
your death. It will not pass according
to the terms of your Will. If you own
property jointly with another person
without right of survivorship, your
interest in that property will pass
according to the provisions in your Will.
NOTE: Idaho and Louisiana residents, contact
your Provider Law Firm for information
particular to your state.
You should know that decisions you
have already made regarding title to
property will determine distribution
of that property in the future. Will
provisions cannot alter those decisions.
A beneciary designation is a binding
contractual obligation and a Will
provision will not alter that designation.
Beneciary designations in life
insurance policies, retirement plans,
annuities, bank accounts with a named
“Due on Death” (DOD) beneciary, etc.,
will determine who receives those
moneys upon your death, not your Will.
If you leave to a named beneciary
real/immovable property which
is mortgaged, that property will
generally pass under your Will to
the beneciary subject to the debt
secured by the mortgage.
If you wish to leave the property free
and clear of the mortgage debt, you
must include a provision in your Will
directing the debt to be paid from the
other assets of your estate, provided
sucient assets are available.
NOTE: Louisiana residents, contact your
Provider Law Firm for information particular
to your state.
Will Questionnaire • p 4 of 6
health care power of
A legal document appointing a
person the authority to make health
care decisions on another persons
physicians directive
(also living will)
A legal document containing
instructions for physicians regarding
your life-support preferences.
(also personal representative)
The person appointed in a Will by the
testator (person making the Will) to
carry out the terms of the Will.
duciary bond
A type of surety bond required by
the court to be filed by executors,
guardians, etc., to ensure proper
performance of their duties as an
executor. Typically waived, especially
when a spouse or family member is
appointed executor.
For Your
Rather than including your funeral
wishes in your Will, which often isn’t
read until after your funeral, it’s best to
make your wishes known to loved ones
in writing prior to your death.
16) Do you wish to disinherit any children or grandchildren? If so list their names here.
If not applicable, please go to question #17.
NOTE: In certain states it is not possible to completely disinherit a spouse or minor child. Please contact
your Provider Law Firm for more information.
17) Execution of a Will is the best way to determine how your property will be
distributed. However, it cannot address important issues regarding health care
decisions. Your Provider Law Firm will prepare a Health Care Power of Attorney
and Physician’s Directive* at no additional charge if prepared with your Will.
* In Alabama, an Advance Directive for Health Care
Who would you like to serve as your representative responsible for making sure
your health care wishes are carried out?
Full name:
Phone number:
Please list an alternate in case this person is unwilling or unable to serve:
Full name:
Phone number:
Please indicate your wishes by checking one box below:
I want this person to be able to act on my behalf immediately.
I want this person to be able to act on my behalf only upon certication by
a doctor that I am no longer able to make decisions and act for myself.
18) If married and your spouse is still alive, do you want your spouse to serve
as your
personal representative/executor*?
* Louisiana & Missouri residents, see back cover.
Please list an alternate below. If not married or you wish to appoint someone other
than your spouse, please indicate below.
NOTE: If you wish to name a non-US resident, please contact your Provider Firm.
Full name:
Please list an alternate in case this person is unwilling or unable to serve:
Full name:
Do you wish to waive the duciary bond requirement? Y N
19) Many people make special provisions for family heirlooms, jewelry, or other items
of special value to be distributed to friends or relatives. If you have such property
and would like to leave it to a specic person, please complete the following.
NOTE: In question #15 you indicated how you would like your assets to pass. Please ll out question #19
ONLY if you desire items with specic or sentimental value be left to a specic person. (Include a separate
sheet of paper if necessary.)
Item Special Identifying Features Recipient
Almost Done!
p 5 of 6 • Will Questionnaire
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For Your
20) List the estimated value of your assets as of today’s date. Include the dollar
amount in the appropriate column(s).
21) List your estimated debt in each category as applicable. Include the dollar
amount in the appropriate column(s).
Conrmation of Information and Instructions:
I conrm the information provided by me in this form is complete and accurate and
that the instructions I have provided reect my wishes.
Print name:
Date: Phone number:
a. Home
c. Checking, savings, or credit union accounts & certicates
d. Automobiles &
Other Vehicles
e. Stocks, Mutual funds
& other investments
h. Life Insurance
i. Miscellaneous
a. Mortgages on
home, car, etc.
b. Signature Loan
at Bank
c. Medical or
other expenses
d. Other debts over
You have now completed your Will Questionnaire! Please see instructions on the next page
for nal steps on how to get your Will prepared.
b. Other real estate*
* Indicate whether in state or out of state.
f. Interest in a business
g. Qualied retirement
plans (e.g. 401k plan)
Joint Assets/
Joint Debts/
Your taxable estate may include all
life insurance on your life and all
joint tenancy property. Tax laws are
constantly changing. If your taxable
estate is larger than $1,000,000 you
should consult with your Provider Law
Firm regarding advanced tax planning
tools available at a discounted rate.
Your estate could be subject to
state inheritance tax even if it isn’t
subject to federal taxation. Please
ask your Provider Law Firm for further
The judicial determination of the
validity of a Will.
Many people think that if their loved one
had a Will prepared, they will be able to
avoid the probate process. This is not
necessarily the case. Please ask your
Provider Law Firm for details about your
Will Questionnaire • p 6 of 6
After completing the Will Questionnaire, mail it to your Provider Law Firm.
If you need to include additional information to this questionnaire, please include
a separate sheet of paper. Your membership guide contains a preaddressed
envelope for mailing your questionnaire to your Provider Law Firm. If you need your
Provider Law Firm’s address, please call their number which you can nd in your
electronic membership kit, via the LegalShield mobile app, or by calling Member
Services toll-free at 1-800-654-7757. Use one stamp for each Will Questionnaire
you send in.
They will prepare your Last Will & Testament based on the condential information
you provide in your Will Questionnaire. If they need additional information from you
while completing your Will, they’ll call you.
Your Provider Law Firm should mail you your completed Will within ten (10)
business days of when they receive your completed Will Questionnaire.
You’ll also receive instructions from your Provider Law Firm on how to have your
Will nalized.
Safeguard your Will and make a copy for your executor.
Store your Will in a safe place with other important legal documents. Please
remember that you—not your Provider Law Firm—are responsible for the
safekeeping of your Will.
Your LegalShield Plan Will Questionnaire
w i l lque s t 8.17 51770 © 2017 LegalShield
Contracts issued by:
Pre-Paid Legal Services, Inc., and subsidiaries:
Pre-Paid Legal Casualty
, Inc.
Pre-Paid Legal Access, Inc.
In FL: LS, Inc.
In VA: Legal Service Plans of Virginia, Inc.
Toll Free: 800.654.7757
* Louisiana & Missouri Residents: Under law, the Personal Representative serves with Court supervision. Certain actions can be taken by your
Personal Representative only after obtaining Court approval, including the sale or transfer of any real estate which is part of your estate. However, you
can waive certain Court supervision by electing “Independent Administrationof your estate. By electing “Independent Administrationthe expenses
associated with probate administration may be lessened. However, because there is less Court supervision, there is a greater chance of dishonesty by the
Personal Representative and they must secure the service of an attorney on legal questions arising in connection with the administration of the estate.
Do you wish to elect “Independent Administration” for your estate? Y N