MARK A. RINALDI, LLC
155 South White Horse Pike, Suite A
Berlin, New Jersey 08009
856-767-6656
LAST WILL & TESTAMENT QUESTIONNAIRE
FULL NAME:
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PRESENT ADDRESS:
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PHONE NUMBER:____________________________________________________________________
CELL NUMBER:____________________________________________________________________
DATE OF BIRTH:______________________________________________________________________
SOCIAL SECURITY NUMBER:____________________________________________________________________
SPOUSE:____________________________________________________________________
CHILDREN:
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GRANDCHILDREN:
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NAME OF PRIMARY BENEFICIARY: ____________________________________________________________________________ ADDRESS OF PRIMARY BENEFICIARY: ____________________________________________________________________________ RELATIONSHIP OF PRIMARY BENEFICIARY: ____________________________________________________________________________ SPECIFIC GIFTS TO SPECIFIC INDIVIDUALS: (add additional pages if necessary) Gift:_________________________________________________________________________ Individual:____________________________________________________________________ Address:______________________________________________________________________ Relationship:___________________________________________________________________ Gift:_________________________________________________________________________ Individual:____________________________________________________________________ Address:______________________________________________________________________ Relationship:___________________________________________________________________ Gift: Individual:_____________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ REMAINDER OF ESTATE TO BE GIVEN TO: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ EXECUTOR OR EXECUTRIX: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ ALTERNATE EXECUTOR OR EXECUTRIX: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ GUARDIAN FOR CHILDREN: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ ALTERNATE GUARDIAN FOR CHILDREN: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ TRUSTEE FOR CHILDREN: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ ALTERNATE TRUSTEE FOR CHILDREN: Name:_________________________________________________________________________ Address:_______________________________________________________________________ Relationship:____________________________________________________________________ TRUST PROVISION: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________