A small estate plan is a plan that does not require tax planning and does not include a trust. If you believe you need either tax planning or a testamentary trust, please let us know.
This questionnaire asks for personal and sensitive information from you. The information you provide in this document is considered both privileged and confidential attorney-client communication. Texas law provides you distinct attorney-client protections regarding the information you provide in this questionnaire, even if you do not retain the services of our firm or attorneys.
Please take the time to complete this questionnaire carefully. Feel free to contact us at 817/877-3355 with any questions.
Untitled Please tell us which documents you would like to have prepared*
Your Information
Full Legal Name*
First
Middle
Last
Other names, prior names, nicknames, or aliases you have used at any time.
Separate each name by a comma if applicable
Phone*
Mobile
Home (optional)
Work (optional)
Alternate (optional)
Email*
Primary
Alternate (optional)
Address*
Street
City*
City
State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific
State
Zip*
Zip Code
County*
County of Residence
Date of Birth*
Social Security Number*
Marital Status* Please select... Married, only marriage Married, previously married Single, never married Single, divorced or widowed
Are you a US Citizen* For each previous marriage state:* Additional rows can be added by clicking the + sign.
Employer
Occupation
Spouse's Information
Spouse's Full Legal Name*
First
Middle
Last
Other names, prior names, nicknames, or aliases your spouse has used at any time.
Separate each name by a comma if applicable
Spouse's Phone*
Mobile
Work (optional)
Spouse's Email
Primary (optional)
Spouse's Full Address (if different from yours)
Street, City, State Zip
Spouse's Date of Birth*
Social Security Number*
Previously Married?* Is Spouse a US Citizen*
For each previous marriage for your spouse state:* Additional rows can be added by clicking the + sign.
Spouse's Employer
Spouse's Occupation
Family Information
Do you have children (biological or legally adopted)? * list your child's name, date of birth, and whether the child is deceased below. You can list more than one child below.
Do you have children (biological or legally adopted)?* Information about your children (both biological and adopted)* Additional rows can be added by clicking the + sign.
Does your spouse have children (biological or legally adopted) from another relaitionship? * list your child's name, date of birth, and whether the child is deceased below. You can list more than one child below.
Spouse's Children?* Information about your children (both biological and adopted)* Additional rows can be added by clicking the + sign.
Do you have grandchildren (biological or legally adopted)? * list your grandchild's name, date of birth, the grandchild's parent (name of your child), and whether the grandchild is deceased below. You can list more than one grandchild below.
Do you have grandchildren (biological or legally adopted)?* Information about your grandchildren (both biological and adopted)* Additional rows can be added by clicking the + sign.
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Will Section Break
WILL INFORMATION
A Last Will and Testament (also known as a Will) is a legal document that allows you to say exactly what you want to happen to your assets and minor children after death. It also allows you to nominate an executor, who will manage your estate, pay your debts, expenses, and taxes, and distribute your estate according to your wishes. This legal document allows you to make decisions on how your estate should be handled after your death; otherwise, the state will have to get involved and your wishes may not align with the decisions made by the state.
Distribution Information
Do you have any specific bequests? * A specific bequest is a gift or specific item or asset that you want to leave to a specific person or entity. For example, you can provide that your Rolex is to go to your son John Smith, that your house be left to the Red Cross, or that each of your three nieces receives $10,000.00. If you select "yes" provide a description of the bequest in the first column, the name of the recipient (person or entity) in the second column, and the person's relationship to you (if applicable) below. Using the example above, put "Rolex" in the first column, "John Smith" in the second column, and "son" in the third column. You can have as many specific bequests as you would like.
Do you have any specific bequests?* Additional rows can be added by clicking the + sign.* Additional rows can be added by clicking the + sign.
How do you want the remainder of your estate to be divided? * The remainder of your estste is all of your assets combined excluding any assets listed as a specific bequest above, if applicable. You need to make a selection below. Information regarding the selections is listed below.
Remainder - Married* Please select... Everything to my spouse, then to my descendants (children and grandchildren) Everything to my spouse, then to my descendants (children and grandchildren), then to others Everything to my spouse, then to others Other (specify below)
If you choose option 1 , everything to my spouse then to my descendants, the remainder of your estate will be left to your spouse if your spouse survives you. If your spouse does not survive you, everything will be left to your descendants in equal shares based on your children. For example, if you have three children and one is deceased but the deceased child has children, those grandchildren will split the deceased child's portion of your estate.
If you choose option 2 , everything to my spouse then to my descendants, then to others, your Will distributes the remainder of your estate like the preceding option; however, if neither your spouse nor any descendants survive you, you can name person(s) or entities to leave your estate to. You will be asked to provide additional information below about how you would like to divide your property.
If you choose option 3 , everything to my spouse, then to others, there will be no reference to children or grandchildren. You will distribute everything to your spouse. If your spouse does not survive you, you can name person(s) or entities to leave your estate to. You will be asked to provide additional information below about how you would like to divide your property.
If you choose option 4 , other, you will be asked to tell us how you would like to divide your estate. You will be asked to provide additional information below about how you would like to divide your property.
Remainder - Single* Please select... Everything to my descendants (children and grandchildren) Everything to my descendants (children and grandchildren), then to others Everything to others
If you choose option 1 , everything to my descendants (children and grandchildren), your Will distributes everything to your descendants in equal shares based on your children. For example, if you have three children and one is deceased but the deceased child has children, those grandchildren will split the deceased child's 1/3 portion of your estate.
If you choose option 2 , your Will distributes the remainder of your estate like the preceding option; however, if you none of your descendants survive you, you can name person(s) or entities to leave your estate to. You will be asked to provide additional information below about how you would like to divide your property.
If you choose option 3 , everything to others, then to others, you will be asked to tell us how you would like to divide your estate. You will be asked to provide additional information below about how you would like to divide your property.
Describe how to distribute your estate to others if your spouse and no children or grandchildren survives you.*
Describe how to distribute your estate to others if your spouse does not survive you.*
Describe how to distribute your estate if no children or grandchildren survive you.*
Describe how you want to distribute your estate.*
Do you have a stepchild that you have not legally adopted that you want to treat as an adopted child in your Will? *
Do you have a stepchild (not legally adopted) that you want to treat as an adopted child in your Will?* Information about your stepchild / stepchildren* Additional rows can be added by clicking the + sign.
Is there anyone you want to disinherit? *
Is there anyone you want to disinherit?* List person(s) to disinherit Additional names can be added by clicking the + sign.
Executor Information
Executor Information . *
The executor/executrix can be almost anyone but is usually a lawyer, accountant, or family member, with the only restriction being that he or she must be over the age of 18 and have no prior felony convictions. Your spouse can act as your executor. The executor can also be a corporation (corporations will normally charge fees). It is generally best to pick an executor that is local.
You can name more than one executor/executrix. If name more than one person, each will act as a co-executor. If you want to have co-executors, make sure the co-executors can work together.
To complete, please list the full name of the executor/executrix in the first column, the executor's gender, and the executor/executrix's address. You can name more than one executor/executrix. You can name more than one person if you want to have co-executors.
Executor Information . *
The executor can be almost anyone but is usually a lawyer, accountant, or family member, with the only restriction being that he or she must be over the age of 18 and have no prior felony convictions. The executor can be a corporation (corporations will normally charge fees). It is generally best to pick an executor that is local.
You can name more than one executor/executrix. If name more than one person, each will act as a co-executor. If you want to have co-executors, make sure the co-executors can work together.
To complete, please list the full name of the executor/executrix in the first column, the executor's gender, and the executor/executrix's address. You can name more than one executor/executrix. You can name more than one person if you want to have co-executors.
Executor Info* Additional rows can be added by clicking the + sign
Do you want to name a successor executor? . *
If you want to name a successive executor (or executrix), please answer "yes" and list the full name of the executor/executrix in the first column, the executor's gender, and the executor/executrix's address below. You can name more than one successor executor/executrix. Leave this blank if you do not want to name a successor.
Successor Executor?* Successor Executor Info Additional rows can be added by clicking the + sign
Do you want your executor to be compensated? *
Executor Compensation*
Minor Child / Grandchild Information
Do you want to name a guardian for a minor child? * A guardian is someone who you name be the caregiver to a minor child or children in the event you are the last surviving parent or guardian. You can name a single person or a couple. If you name a couple, they will act as co-guardians. You can also appoint a successor guardian or guardians in the event that the appointed guardian(s) are unable or refuse to serve. If you answer yes, name the guardian(s) in the first field below and successor guardian(s) in the second field.
Appoint guardian?* Name of Guardian(s)* Additional guardians can be added by clicking the + sign
Name of Successor Guardian(s) Additional guardians can be added by clicking the + sign
Do you want to include a contingent trust for a minor beneficiary? * A contingent trust is a trust which designates an age or ages that a minor beneficiary will be able to receive their portion of your estate. The contingent trust protects the assets you set aside for the minor beneficiary from the appointed guardian's creditors and allows the trustee to use the money for customary expenses. The remainder will be distributed upon a certain age or ages (preferably after the child has matured enough to handle the inheritance).
Contingent trust* Do you want to distribute the trust at a specified age or in three installments?* Age trust property will ne delivered to beneficiaries*
Age first 1/3 of trust property will be delivered to beneficiaries*
Age first 1/2 of remaining trust property will be delivered to beneficiaries*
Age remaining trust property will be delivered to beneficiaries*
Who do you want to name as a trustee for the contingent trust? * You need to name a trustee to manage the contingent trust. The trustee will manage and distribute assets used for the comfort, care, and education of your minor beneficiaries until they have attained a specified age. You can name more than one trustee. If you have named a guardian for your minor children, the trustee can be the named guardian(s). You can also appoint a successor trustee or trustees in the event that the appointed trustee(s) are unable or refuse to serve. Name the trustee(s) in the first field below and successor trustee(s) in the second field.
Name of Trustee(s)* Additional trustees can be added by clicking the + sign
Name of Successor Trustee(s) Additional trustees can be added by clicking the + sign
Additional Information
Do you want a no-contest clause? * A no-contest clause is a provision in the will that prohibits a beneficiary from taking any portion of your estate if the beneficiary contests the will (unless a court determines the contest was made for just cause and in good faith).
No Contest Clause
Power of Attorney Section Break Power of Attorney - Agent* Power of Attorney - Successor Agent* Power of Attorney - Grant of Authority* Special Instructions*
When is the Power of Attorney effective?* Do you want your agent to have the ability to make gifts? Do you want your agents(s) to be entitled to compensation? Medical Power of Attorney Section Break Primary Agent's Information* Additional agents can be added by clicking the + sign.
Alternate Agent's information (optional) Additional agents can be added by clicking the + sign.
List any limitations on the decision making authority of the agent(s).
Location of the original Medical Power of Attorney*
List each person or institution you want to have a signed copy of the Medical Power of Attorney Duration of the Medical Power of Attorney* The Medical Power of Attorney can last for an indefinite period of time or it can terminate on a specific date. Indefinite is the most common response; however, a specific date may be appropriate if you want the Medical Power of Attorney to last for a short period, for instance, to get through a surgical procedure.
Expiration Date
The date the Medical Power of Attorney expires
Directive to Physician Section Break Directive to Physician - Agents HIPAA Section Break HIPAA INFORMATION
Your healthcare information is protected, meaning healthcare providers cannot release your medical information without a release. A HIPAA Release is a legal document that permits someone you authorize access to your personal medical information.
Who do you want to have access to your medical information? *
Name of person(s) you want to have access to your medical information.* Additional names can be added by clicking the + sign.
When do you want the HIPAA to start? *
HIPAA Start* Beginning date for HIPAA Release*
When do you want the HIPAA to end? *
When does the HIPAA expire?* Ending date for HIPAA Release.*
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Disclaimer Section Break Disclaimer* DISCLAIMER: The contents of this contact form are being provided so that Hawkins & Walker, PC can evaluate your case. Upon evaluation, Hawkins & Walker, PC may send a new client contact, which contains a formal representation agreement and instructions for payment. This form does not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. An attorney-client relationship will only be created upon your acknowledgment of the terms contained in the Municipal Citation Retainer Agreement and payment of applicable attorneys’ fees.
I confirm that I have read and foregoing disclaimer.
