Write a Will Form

Complete this form to present to the attorney for your Simple Will with Charitable Gift.

Please print

Your name as you will sign on your document_________________________________________ Address__________________________________________________________________________ Phone Number____________________________________________________________________

Your marital status ___________________ Name of spouse: _____________________________ Do you have children? ________ How many? __________ Are any children minors? __________

BENEFICIARIES OF YOUR ESTATE AT DEATH: 1. Charities a. Official Name Address

b. Official Name Address Amount or Percent

2. Others (Name) Relationship Amount or Percent

WHO WILL SERVE AS YOUR EXECUTOR? 1. Name_____________________________ Address ________________________________________ ________________________________________ 2. Alternate _________________________ Address ________________________________________ ________________________________________ How will your tangible personal property (i.e. furniture, jewelry, etc.) be distributed? Spouse _______ Children in equal shares ________ Sold and proceeds added to remainder of estate_________ Other _______________________________________________________________________________________

You may arrange for additional provisions or other documents for a fee: Power of Attorney, Advance Directives for Health Care, Appointment of Guardian, Trust provisions. Please consult your attorney.

YOUR DOCUMENT MAY BE EXECUTED AT A LATER DATE BY APPOINTMENT An Initiative of the CHARITABLE GIFT PLANNERS OF NORTHEAST INDIANA www.cgpni.com