Will & Estate

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Section

Full name(s) and date(s) of birth of person(s) making will(s):

Full name of person(s) you wish to receive the assets of your estate (usually spouse, if applicable):

In the event the person(s) you wish to receive the assets of your estate pass away before you, an alternate person (s) you wish to receive the assets of your estate (usually children, if applicable):

Name and address of person(s) you wish to be Executor (person who carries out the will)

First Choice:

Usually spouse if applicable

First Alternate:

Name and address of person(s) you wish to be Guardian of your children if both spouses die:

Name and address of person(s) you wish to be Guardian of your children if both spouses die (Guardian has physical and legal custody of children)

First Choice:

First Alternate:

Specific bequests: If there are specific pieces of your property that you want to go to specific people (land, artwork, jewelry, guns, automobiles, etc.), please list those items here and state who you want to receive them. If no items are specifically listed, all your property will go to the heirs identified in response to question 6. If there is more than one heir, they will inherit all of your property as equal joint owners unless otherwise designated:

*List items and names

Do you own an interest in any LLC, PLLC, LLP, LP, general partnership or corporation?

Yes

If so, please list the name of the entit"(ies) and its state of incorporation.

Name and address of person(s) you wish to be Trustees of trusts for your surviving spouse or your children if both spouses die (Trustee has control of monies/property put into trusts under the Will):

First Choice:

First Alternate

Name and address of person(s) you wish to be your attorney-in-fact:

Attorney-in-fact has the right to manage your affairs if you are still living but become incapacitated:

First Choice:

First Alternate:

Name and address of person(s) you wish to make end-of-life healthcare decisions in the event you become incapacitated?

This person has the right, in conjunction with the treating physician to decide if life support should be terminated

First Choice:

First Alternate:

Primary treating physician:

*Optional – if you don’t put anything here, your treating physician will be the physician that is managing your treatment at the time of final illness

Alternate Treating Physician

*Optional

How would you prefer to handle end-of-life healthcare decisions in the event you are incapacitated or otherwise unable to make your own healthcare decisions and (i) have an incurable and irreversible condition that will result in your death within a relatively short time; (ii) you become unconscious and, to a reasonable degree of medical certainty, will not regain consciousness; or (iii) the likely risks and burdens of treatment would outweigh the expected benefits?

Please Choose One

I wish for my life to be prolonged as long as possible within the limits of generally accepted health-care standards.

I do not want my life to be prolonged.

Allow the person designated in response to question 13 to make the decision in conjunction with my treating physician.

Licensed in Mississippi