Halperin Lyman, LLC - Will Questionnaire

1
What is your full legal name?* This field is requiredPlease include your First name, Middle name(s), Last Name(s), any Suffix.
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2
Please enter in your date of birth.* This field is required
Month
Day
Year
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3
Please enter in your Phone Number.* This field is required
Area Code
Phone Number
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4
Please enter in your Email address.* This field is required
example@example.com
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5
Please include your primary mailing address.* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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6
Do you already have a Will?
YESNO
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7
What is the approximate date of the earlier Will?
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8
Are you able to bring in all of the originals of your earlier Will?
Yes, I can bring in the original Will documents.
No, I cannot bring in any of the earlier Will documents because I do not have them or do not know where they are located.
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9
If you already have a Will, what are the changes you wish to make?
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Ok
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10
Are you married?
YESNO
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11
What is the full legal name of your Spouse?
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12
Do you have children?
YESNO
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13
Please list the names of all of your children and include their ages. Include also any special circumstances (including if they are deceased, were adopted by you, or were born of a prior marriage or relationship).Example: Ann Johnson, 34 (dec.) and Michael Smith, 29, both born to current spouse.
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14
If any child is a minor child (currently under the age of 18 years old), please include the name of the person you wish to be named as the child's Legal Guardian.
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15
Please list the names of your Mother, Father, and Siblings (if any), Neices/Nephews (if any) and please indicate if they are deceased.
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16
Do you have specific items or specific cash gifts that you would like to devise to specific people?
YESNO
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17
Please list any specific items and the specific person that you would like to inherit.Example: Any car I own at the time of my death to my cousin, Andy Johnson. Example: $2,000 cash to my best friend Stella Johnson. Example: All of my jewelry to my granddaughter Ella Simpson.
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18
Generally, how would you like your assets to be devised?Example: Equally, to my children. Or, example: One half to my son and the other half to a charity for animals.
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19
Please include the full legal name for the person you wish to appoint as your Executor, and their relationship to you.* This field is requiredExample: Jane Smith, Daughter
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20
Please include contact information for your Executor, including their Phone Number, Mailing Address, and Email Address.Example: 815-410-2210; 123 Main Street Jonesboro, GA 30020; JaneSmith@AOL.Com
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21
Please include the full legal name for the person you wish to appoint as your Alternate Executor, and their relationship to you. Note: If you do not have an alternate to name, you can request the court appoint an alternate.* This field is requiredExample: James Smith, Son
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22
Please include contact information for your Alternate Executor, including their Phone Number, Mailing Address, and Email Address.Example: 815-410-2210; 123 Main Street Jonesboro, GA 30020; JaneSmith@AOL.Com
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Ok
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23
Please describe your desired End of Life arrangements:
I wish to be buried.
I wish to be cremated.
I am uncertain or have no preference at this time.
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24
Please include any wishes or details regarding burial or cremation services in the field below.You may be as specific or as general as you wish.
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25
Additional Questions or CommentsPlease include any additional comments or questions in the box below. A member of our team will respond within 1-3 business days. Thank you for your business.
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