www.volsprobono.org
Information needed for
Life-Planning Documents
The VOLS Elderly Project refers eligible New Yorkers age 60+ to lawyers at our
many partner law firms to obtain wills and advance directives free of charge.
Please fax this form to (347) 521-5732.
The Last Will and Testament
Your name: ____________________________________
Address:
_____
______ New York, NY 100 __
Telephone #(s): ________________________________________________________
Marital/Relationship Status (Circle one) :
Married / Divorced / Legally separated / Informally separated / Widowed /
Never married / Long-term partner
Do you have children?
Yes No If YES, how many? _____
Below, please provide the names and addresses of all living children OR, if
you have no living children, please provide the names and addresses of your
closest living relatives:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
40 WORTH STREET, SUITE 820 | NEW YORK, NY 10013 | PHONE: 212-966-4400 | FAX: 347-521-5732 | WWW.VOLSPROBONO.ORG
Below, please explain how you would like your property to be distributed
upon your death. Please be specific, with names and addresses of the persons
whom you would like to inherit your money and possessions, along with the
type of bequest, dollar amount or percentage of estate, etc. Feel free to use
another page if needed, and bear in mind that you will be able to discuss your
wishes in detail with the lawyer who will represent you.
Some items to consider:
a) Who will inherit the physical contents of your apartment?
b) Would you like to leave any specific objects – such as items of jewelry –
to any particular person(s)?
c) Do you own a piece of property, such as a house or coop apartment,
either in New York or in some other state or country?
d) Who will inherit the contents of your bank account(s)?
e) If a beneficiary of your will dies before you do, who would you like to
inherit that deceased beneficiary’s share of your estate?
f) Important: Your will does not control any bank account, investment
account, or insurance policy in which you have named a beneficiary, so
long as the beneficiary is alive at the time of your death.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Who would you like to be the Executor of your Will? The back-up Executor?
An Executor’s job is to protect a deceased person's property until all debts and taxes have been
paid, and then to see that what's left is transferred to the people who are entitled to it. You may
name up to two executors and up to two back-up executors.
Executor #1 Name
_____________________________________________
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Executor #1 Address
_____________________________________________
Executor #1 Telephone # _____________________________________________
Executor #2 Name
_____________________________________________
Executor #2 Address
_____________________________________________
Executor #2 Telephone # _____________________________________________
Please note whether Executor #2 is to be a co-executor or a back-up executor.
Durable Power of Attorney
A Durable Power of Attorney is a powerful document that gives legal authority to another person
(called an “Agent”) to make property, financial, and other legal decisions for the “Principal”
(you are the Principal). The Durable Power of Attorney is often used to help in the event of a
Principal's illness or disability.
Who would you like to appoint as your Agent? __________________________
Address ___________________________________________________________
Would you like to appoint a second agent (a Co-Agent)? __________________
Address ___________________________________________________________
Would you like to appoint a Successor Agent? Name: ____________________
Address __________________________________________________________
Health Care Proxy
A Healthcare Proxy is a document where you (the “Principal”) name another person (your
“Agent”) to make medical decisions for you if you cannot make them yourself. This is different
from a Living Will, in which you say what treatment and care you would want or not want at the
end of your life. The Living Will does not name a person to make decisions.
Who would you like to appoint as your Agent? ______________________
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Address _________________________________________________ ______
Telephone #_____________________________________________________
Would you like to appoint a Successor Agent? Name: __________________
Address __________________________________________________________
Telephone #_______________________________________________________
Burial or Cremation Planning
You may designate a person to handle the disposition of your remains – that is, your burial,
cremation, or funeral – in a “Control of Body Form”. You may include specific information,
such as the location of your burial plot, or the place where you would like your ashes scattered.
Who would you like to appoint as your Agent? __________________________
Address ___________________________________________________________
Would you like to appoint a Successor Agent? Name: ____________________
Address____________________________________________________________
My preference is: a) to be buried
b) to be cremated
c) I have no preference
Is there anything else that you would like us to know? Please feel free to
provide, below, any additional information that you believe we should have:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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