| COMPLEX LAST WILL & TESTAMENT INFORMATION SUMMARY AND INQUIRY TO SPIEGEL & UTRERA, P.A. |
| OUR GOAL—YOUR Complete Satisfaction and UnderstandingShould you order this document from Spiegel & Utrera, P.A., Spiegel & Utrera, P.A., will incorporate your basic information into a draft document that will be conveyed to you for your review and make reasonable changes upon request. |
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| Please complete where applicable |
| Name: | *required |
| City: | |
| State: | |
| Telephone: | *required |
| Cellular Phone: | |
| Fax: | |
| Email: | *required |
| What do some of these terms mean? Click here for a Glossary. |
| Testator or Testatrix's Name: | |
| Testator or Testatrix's Social Security Number: | |
| Spouse of Testator or Testatrix | |
| Spouse of Testator or Testatrix's Social Security Number: | |
| Testator or Testatrix's Telephone Number: | |
| Testator or Testatrix's Fax Number: | |
| Testator or Testatrix's Email: | |
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| Testator or Testatrix's Address: | |
| Testator or Testatrix's Street: | |
| Testator or Testatrix's City: | |
| Testator or Testatrix's State: | |
| Testator or Testatrix's Zip Code: | |
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| Testator or Testatrix's Mailing Address: | |
| Testator or Testatrix's Mailing Street: | |
| Testator or Testatrix's Mailing City: | |
| Testator or Testatrix's Mailing State: | |
| Testator or Testatrix's Mailing Zip Code: | |
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| LAST WILL & TESTAMENT |
| Name of Last Will & Testament Personal Representative, Executor or Executrix: | |
| Optional Address of Last Will & Testament Personal Representative, Executor or Executrix: | |
| Last Will & Testament Personal Representative, Executor or Executrix's Relationship to Testator or Testatrix: | |
| Last Will & Testament Personal Representative, Executor or Executrix's Telephone Number: | |
| Special Instructions to Last Will & Testament Personal Representative, Executor or Executrix: | |
| Name of Successor Last Will & Testament Personal Representative, Executor or Executrix: | |
| Optional Address of Last Will & Testament Personal Representative, Executor or Executrix: | |
| Successor Last Will & Testament Personal Representative, Executor or Executrix's Relationship to Testator or Testatrix: | |
| Successor Last Will & Testament Personal Representative, Executor or Executrix's Telephone Number: | |
| Special Instructions to Successor Last Will & Testament Personal Representative, Executor or Executrix: | |
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| Name of Beneficiary 1 of Last Will & Testament: | |
| Optional Address of Beneficiary 1 of Last Will & Testament: | |
| Beneficiary 1's Relationship to Testator or Testatrix: | |
| Beneficiary 1's Percentage | |
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| Name of Beneficiary 2 of Last Will & Testament: | |
| Optional Address of Beneficiary 2 of Last Will & Testament: | |
| Beneficiary 2's Relationship to Testator or Testatrix: | |
| Beneficiary 2's Percentage | |
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| Name of Beneficiary 3 of Last Will & Testament: | |
| Optional Address of Beneficiary 3 of Last Will & Testament: | |
| Beneficiary 3's Relationship to Testator or Testatrix: | |
| Beneficiary 3's Percentage | |
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| Name of Beneficiary 4 of Last Will & Testament: | |
| Optional Address of Beneficiary 4 of Last Will & Testament: | |
| Beneficiary 4's Relationship to Testator or Testatrix: | |
| Beneficiary 4's Percentage | |
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| ASSETS - Please indicate the assets held by the Testator or Testatrix below and describe as applicable |
| Residence/Home (Please provide a short description including the names(s) of the owner(s) that hold title, mortgage(s) (quantity and amount(s)), location (city and state), and approximate value). | |
| Other Real Estate (Please provide a short description including the names(s) of the owner(s) that hold title, mortgage(s) (quantity and amount(s)), location (city and state), and approximate value). | |
| Cash and cash equivalents (Please provide a short description including the name(s) of the account owner(s), location (city and state), and approximate value). | |
| Investments | |
| Life Insurance | |
| IRA Accounts | |
| Other Retirement Accounts | |
| Notes, Mortgages and Obligations | |
| Other Assets or Income | |
| Other Property (car, boat, motorcycle, antiques) | |
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