Names
Home Address:
Mailing Address
How Long? (years)
Home Phone No.
Work Phone No.
Date of Marriage:
Place of Marriage (city,
county, state)
MALE
SPOUSE:
Soc. Sec. No.
Date of Birth
Place of Birth
If Decease, date of death:
Place of Death
Will probated where:
Employer:
Employer Phone No:
Employer Address:
Title:
FEMALE SPOUSE
Maiden Name:
Other Last Names:
Soc. Sec. No:
Date of Birth:
Place of Birth:
If Deceased, date of
death:
Place of Death:
Will probated where:
Employer:
Employer Phone No:
Employer Address:
Title:
Children Born / Adopted
of this marriage:
Date of Birth:
Place of Birth:
HUSBAND'S
OTHER CHILDREN:
Date of Birth:
Place of Birth:
Address:
WIFE'S
OTHER CHILDREN:
Date of Birth:
Place of Birth:
Address:
II.
PROPOSED DISPOSITION OF ESTATE
HUSBAND'S WILL:
Executor to be your Wife?
If not please give name/address:
Alternate Executor:
Address:
If your wife dies before
your death, or within 30 days of your death,
who would you ask the Probate court to name
as the Guardian of your minor child(ren). If
any:
Alternate Guardian:
What assets to wife,
if she survives for 30 days:
All property?
If not, list separate page what she is to inherit and which
is to go to others.
If wife does no survive
you for 30 days:
All property to children
of this marriage, equally?
If not, list on separate page who is to receive what parts
of your estate.
All property to children
of this and previous marriage, equally?
If not, list on separate page who is to receive what parts
of your estate.
If any of the children's
names as contingent beneficiaries predecease
you or fail to survive you for 30 days, are
the then living descendants (your grandchildren)
to receive that child's inheritance?
Or, is such share to
go the names children who survive you for 30
days?
If neither apply, set forth details on supplemental sheet.
Name(s) of Those Whom
You Want to Disinherit:
Funeral Service Desired:
(church, funeral home, cremation, masonic)
WIFE'S WILL:
Executor to be your Husband?
If not please give name/address:
Alternate
Executor:
Address:
If your husband dies
before your death, or within 30 days of your
death, who would you ask the Probate court to
name as the Guardian of your minor child(ren).
If any:
Alternate Guardian:
What assets to husband,
if he survives for 30 days:
All property?
If not, list separate page what he is to inherit and which
is to go to others.
If husband does not survive
you for 30 days:
All property to children
of this marriage, equally?
If not, list on separate page who is to receive what parts
of your estate.
All property to children
of this and previous marriage, equally?
If not, list on separate page who is to receive what parts
of your estate.
If any of the children's
names as contingent beneficiaries predecease
you of fail to survive you for 30 days, are
the then living descendants (your grandchildren)
to receive that child's inheritance?
Or, is such share to
go the named children who survive you for 30
days?
If neither apply, set for the details on supplemental sheet.
Name(s) of Those Whom
You Want to Disinherit:
Funeral Service Desired:
(church, funeral home, cremation, masonic)
ADDITIONAL PRE-DEATH DOCUMENTS TO CONSIDER AS PACKAGE
THE
FOLLOWING MATTER SHOULD BE CONSIDERED ALONG
WITH YOUR WILL EVEN THOUGH THEY TAKE EFFECT
IMMEDIATELY.
DURABLE
POWER OF ATTORNEYS: This allows the appointee
to handle your general or specific affairs if
you become disabled, ill, or leave the country.
Do You Want This Law
Firm to Prepare a Power of Attorney for:
HUSBAND: Do you want
your wife named as appointee?
If no, give name &
address
WIFE: Do you want your
husband named as appointee?
If no, give name &
address
DURABLE POWER OF ATTORNEY
FOR HEALTH CARE: Ohio law now allows
you the right to designate a person to make
medical decisions for you (pull life support
system if brain dead, select doctor, select
medical procedures, select hospital, select
nursing home etc. See the mandatory disclosure
that will accompany the form.) The above power
of attorney will not do this.
Do You Want This Law
Firm to prepare a Durable Power of Attorney
for Health Care for:
HUSBAND: Do you want
your wife named as appointee?
If no, Name
Relationship
Address
Phone
First Alternate Name
Relationship
Address
Phone
Second Alternate Name
Relationship
Address
Phone
WIFE: Do you want your
husband named as appointee?
If no, Name
Relationship
Address
Phone
First Alternate Name
Relationship
Address
Phone
Second Alternate Name
Relationship
Address
Phone
C.
LIVING WILL
Husband
Wife
DISCLAIMER
SUBMISSION
OF FALSE INFORMATION ON THIS FORM MAY BE A CRIME
UNDER THE REVISED CODE OF OHIO.
