Complete and fax/mail to: Steven Lulich, P.A.
1069 Main Street
PO Box 781390
Sebastian, Florida 32978
Phone (561) 589-5500
FAX (561) 589-8800
SIMPLE WILL QUESTIONNAIRE
FULL (LEGAL) NAME
__________________________________________
SPOUSE'S (LEGAL) NAME
__________________________________ PHONE________________
___________________________
ADDRESS
_____________________________________________________________
______________________________________ COUNTY _______________
BENEFICIARIES
SPECIFY; Full Name, Relationship, Natural, adopted, or step
children and age.
______________________________________________________________
______________________________________________________________
______________________________________________________________
SUCCESSOR BENEFICIARIES
SPECIFY as above;
___________________________________________________
___________________________________________________
If you have multiple beneficiaries and one or more of them
die before you do, do you want their share to go to the
surviving beneficiaries or to their lineal descendants
(blood line heirs)? Choose one, surviving or lineal
_______________________________________
PERSONAL REPRESENTATIVE - The executor or person who will
take inventory of all the assets including your remains and
disburse them, SPECIFY;
Full (Legal) Name __________________________________________
successor personal rep;
Full (Legal) Name __________________________________________
Do you want to be Cremated?
Yes __________ No ______________
(If Applicable) Full Legal Name
Do you own your residence?
Yes_______ No _______
Is it your (homestead) Permanent Residence?
Yes _______ No _______
Do you want a Testamentary Trust Clause? $50.00 each
Yes _______ No _______
Power Granted to _______________________________
If you have minor children, answer the following;
Who shall be the Guardian?
________________________________________________
Full (Legal) Name
Who do you want to manage the finances as Trustee?
________________________________________________
Full (Legal) Name
Who will be Successor Trustee?
________________________________________________
Full (Legal) Name
What age shall child or children receive the balance of
the assets?
18 Years Old _______ 25 Years Old _______Other _______
Do you want a Living Will? Living Will $30.00 each
Yes _______ No _______
Do you want a Durable Power of Attorney? $30.00 each
His: Yes _______ No _______
Power Granted to _______________________________
Full Legal Name
Successor ______________________________________
Full Legal Name
Hers: (If Applicable) Yes _______ No ________
Power Granted to ________________________________
Full Legal Name
Successor _____________
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Payment Methods:
By Mail:
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Send check to: Steven Lulich, P.A.
1069 Main Street
PO Box 781390
Sebastian, Florida 32978
By Fax or Phone:
----------------
Charge by: (circle one) Visa Mastercard
Name as it appears on card ______________________________________________
Credit Card No: ________________________________ Expiration: ____/____
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