D E LO A C H , P . L .
IMPORTANT PLAYERS IN YOUR ESTATE
PERSONAL & CONFIDENTIAL
(1)
Beneficiaries. Name all children, as well as any other beneficiary who will inherit a portion
of your estate.
Legal Name (First Middle Last):
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Date of Birth:
SSN (children only):
Legal Name (First Middle Last):
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Date of Birth:
SSN (children only):
Legal Name (First Middle Last):
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Date of Birth:
SSN (children only):
Legal Name (First Middle Last):
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Date of Birth:
SSN (children only):
Legal Name (First Middle Last):
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Date of Birth:
SSN (children only):
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
1206 East Ridgewood Street ● Orlando, Florida 32803
407.480.5005 Telephone ● 407.480.5025 Facsimile
[email protected]
www.deloachplanning.com
(2)
Lifetime Financial Decision Makers (Durable Power of Attorney). If you were sick and
could not pay your bills, whom would you wish to handle your financial affairs?
Client 1 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Client 2 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
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(3)
Healthcare Decision Makers (Designation of Healthcare Surrogates and Living Will). If you
were unable, whom would you wish to make healthcare decisions for you?
Client 1 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Client 2 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
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(4)
Personal Representative/Trustee. Whom do you wish to handle your financial/estate
affairs upon your death?
Client 1 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Client 2 Name:
1st Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
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*Fill out this section only if you have minor children.
(5)
Guardian for Minor Children. Whom do you wish to take care of your minor children upon
your death(s)? If you name a couple, please indicate if one of them may act alone.
Client 1 Name:
Minor's Name:
1st Choice
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Minor's Name:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Minor's Name:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Client 2 Name:
Minor's Name:
1st Choice
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Minor's Name:
2nd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Minor's Name:
3rd Choice:
Relationship:
Street Address:
City, State, Zip:
Home Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
Cell Phone:
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(6)
Distribution of your estate. Upon your death (or the death of the surviving spouse, if
married), who will receive the following assets? Please provide the complete legal name of any
recipient, whether an individual or a charitable organization.
Personal Property. Items in your home. Not to include items with titles or bank accounts.
Name:
Relationship:
City/State of Residence:
Percentage:
Name:
Relationship:
City/State of Residence:
Percentage:
Name:
Relationship:
City/State of Residence:
Percentage:
Name:
Relationship:
City/State of Residence:
Percentage:
Vehicles.
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Primary Residence.
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Specific Bequests and Devises. Specific business interests, gifts, or real property (other than your
primary residence).
Name:
Relationship:
City/State of Residence:
Item:
Name:
Relationship:
City/State of Residence:
Item:
Name:
Relationship:
City/State of Residence:
Item:
Name:
Relationship:
City/State of Residence:
Item:
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(6)
Distribution of your estate continued.
Distribution of Residuary. All remaining assets not otherwise mentioned above.
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Name:
City/State of Residence:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
Relationship:
Percentage:
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