The Law Firm of COLIN M. QUINN

April 19, 2024

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I. PERSONAL INFORMATION

Full Legal Name

Spouse

Address

Telephone No. (Home)

(Work)

E-mail Address

Are you, your spouse and children, if any, U.S. Citizens?

Yes

If no, what is your Citizenship?

Any existing Will?

Yes

If Yes, please forward a copy of Will (not the original)

Have you created any Trusts?

Yes

If Yes, please forward a copy(not the original)

Are you the beneficiary of a Trust?

Yes

If Yes, please forward a copy(not the original)

Any existing Premarital Agreements?

Yes

If Yes, please forward a copy(not the original)

If any prior marriages, list dates, places of termination, and any continuing support obligations.

II. BENEFICIARY INFORMATION

Spouse:
Date and Place of Birth & Citizenship

Does your spouse, any child or any grandchild have a physical, mental or emotional disability?

Yes

If Yes, please explain the individual’s special needs.

Does your spouse, any child or any grandchild have special financial needs?

Yes

III. EXECUTORS, TRUSTEES AND GUARDIANS

If you have decided, we need your preliminary answers to the following questions:
A.You must decide who the Executor and Successor Executor of your Estate will be.
Executor:
Successor Executor:
B.A child under 18 years of age must have a Guardian. Who will care for that child if both spouses are deceased. You also need to name a Successor Guardian.
Guardian:
Successor Guardian:
C.Who is to be the Individual Trustee of Trusts created by your Will? (The Guardian of your Estate named above may also be the Individual Trustee of any Trust you create.) We also need your choice for Successor Individual Trustee.
Trustee:
Successor Trustee:

IV. INDIVIDUAL BEQUESTS

You need to identify in your estate plan if you intend to bequeath any real property, cash, or other item(s) to any individual, church, school, or other charitable organization.

V. OTHER ESTATE PLANNING DOCUMENTS

A. Health Care Power of Attorney
We recommend that you have a “Health Care Power of Attorney” prepared, whereby you would appoint an Attorney-in-Fact, who can be a relative or friend, to make decisions regarding medical treatment on your behalf in the event you were unable to do so (i.e., comatose or otherwise incompetent or deemed incapable of making decisions on your behalf).
Attorney-in-Fact:
Alternate Attorney-in-Fact:
B. Durable Power of Attorney
We recommend that you have a “Durable Power of Attorney” prepared, whereby you would appoint an Agent to handle your property and affairs. This Power of Attorney would survive your disability or incapacity. As with the Health Care Power of Attorney, you should choose an Attorney-in-Fact and Alternate which do not have to be the same people chosen as your Health Care Power of Attorney-in-Fact.
Attorney-in-Fact:
Alternate Attorney-in-Fact:

VI. MISCELLANEOUS

In connection with preparing answers to this Questionnaire, you may have questions which have not previously been answered. If that is the case, please list them below and on an additional sheet (if necessary):