Wills Package Questionnaire

You must be a Virginia resident to qualify for these services.
If the service member's spouse wants these services, he or she must fill out a separate questionnaire.
You must bring a government issued photo i.d. to the meeting.

Wills Package Questionnaire PDF Version - Click Here

Wills Package Questionnaire Word Version - Click Here

Fill out one of the above, and email or mail it back.

Or fill out the electronic form below and hit submit.

If you are a human, ignore this field

Date:
Full Legal Name *
City *
State *
Zip Code *
Address *
Telephone
Resident of the City or County of (must be in Virginia) *
Marital Status *
Do you own a business? *
Full Legal Name of Business
Business Type (LLC, Partnership, etc.)
Is any of your property owned jointly with another person?
Co-Owner
Type of Property
Choose the Will you desire. - Select Only One Option -
OPTION A:
All of my property to my spouse. If my spouse does not survive me, all of my property will be divided equally among my children.

Name of Spouse:
Name(s) of Children:
OPTION B:
All of my property divided equally among my children.

Name(s) of Children:
OPTION C:
All of my property to a designated person or to an alternate person if the person first named does not survive me.

Name of Beneficiary:
Name of Alternate Beneficiary:
OPTION D:
All of my property divided equally among designated persons who survive me.

Name of Beneficiaries:
Omitted Children: Name(s) of children who you do not want to inherit anything:
Who do you wish to serve as Executor of your Estate? (The person who handles 3 collecting and distributing your property according to your will. Must be 18 or older).

Full Legal Name of Executor:
Executor’s Telephone and Email:
Executor’s Address:
Full Legal Name of Alternate Executor:
Alternate Executor’s Telephone and Email:
Alternate Executor’s Address:
GUARDIANS: Only for people who have children under the age of 18.
Who do you wish to serve as the Guardian of the person and property of your minor child/children?

Full Name of Minor Children:
Full Legal Name of Guardian:
Guardian’s Telephone and Email:
Guardian’s Address:
Full Legal Name of Alternate Guardian:
Alternate Guardian’s Telephone and Email:
Alternate Guardian’s Address:
*DURABLE GENERAL POWER OF ATTORNEY (Definition below)
Name of the person you would like to appoint as your agent under a durable general power of attorney.

Full Legal Name of Agent:
Durable General Power Of Attorney
Agent's Telephone and Email:
Durable General Power Of Attorney
Agent's Address:
Durable General Power Of Attorney
Full Legal Name of Alternate Agent:
Durable General Power Of Attorney
Alternate Agent's Telephone and Email:
Durable General Power Of Attorney
Alternate Agent's Address:
**ADVANCE MEDICAL DIRECTIVE (Definition below)
Name of the person you would like to appoint as your agent for health care decisions.

Full Legal Name of Agent:
Advance Medical Directive
Agent's Telephone and Email:
Advance Medical Directive
Agent's Address:
Advance Medical Directive
Full Legal Name of Alternate Agent:
Advance Medical Directive
Alternate Agent's Telephone and Email:
Advance Medical Directive
Alternate Agent's Address:
***LIVING WILL (Definition below)

Would you like following optional provision that directs your health agent and physician how to treat you when nothing more can be done for you?
****POWER OF ATTORNEY FOR FUNERAL AND DISPOSITION OF REMAINS (Definition below)

Full Legal Name of Agent:
Power Of Attorney For Funeral And Disposition Of Remains
Agent's Telephone and Email:
Power Of Attorney For Funeral And Disposition Of Remains
Agent's Address:
Power Of Attorney For Funeral And Disposition Of Remains
Full Legal Name of Alternate Agent:
Power Of Attorney For Funeral And Disposition Of Remains
Alternate Agent's Telephone and Email:
Power Of Attorney For Funeral And Disposition Of Remains
Alternate Agent's Address:

*DURABLE GENERAL POWER OF ATTORNEY:

A durable power of attorney allows the agent that you appoint to conduct business and to deal with your money and property on your behalf. You should only select someone you trust. The durable power of attorney does not terminate on your disability, incompetence or incapacity. The power automatically ends on death. A durable power of attorney does not authorize your agent to make health care decisions for you.

**ADVANCE MEDICAL DIRECTIVE:

A medical directive appoints an individual to act as your agent and to make health care decisions on your behalf. The power granted becomes effective only when you are declared unable to make your own medical decisions. You should appoint someone who will carry out your wishes.

***LIVING WILL:

If at any time my attending physician should determine that I have a terminal condition where the application of life-prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. In the absence of my ability to give directions regarding the use of such life-prolonging procedures, it is my intention that this declaration shall be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.

****POWER OF ATTORNEY FOR FUNERAL AND DISPOSITION OF REMAINS:

Name of the person you would like to appoint as your agent for funeral arrangements and the handling of your remains. This person is usually the same as your agent for health care decisions.

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