Planning Your Legacy - Arkansas Baptist Foundation

GENERAL INFORMATION

MARITAL STATUS*

Married
Single
Widowed

Church Membership

Full Legal Name*

(Spouse)

Address*

Street Address Address Line 2 City State / Province / Region ZIP / County

Home Phone

Work Phone

(Spouse)

Cell Phone*

(Spouse)

Email Address*

(Spouse)

Occupation*

(Spouse)

Date of Birth*

(Spouse)

Previous Marriage?*

YES
NO

(Spouse)

YES
NO

Information about Children

Name of Child	Date of Birth	Address	Phone	Marital Status	# of Children (grandchildren)

Please use the "+" to add additional rows for your children if needed.

ESTATE ADMINISTRATION

Please select the following documents you would like drafted and list who you would like responsible for each. If you and your spouse would like different people responsible, please use the "+" to list spouse wishes.

Last Will and Testament*

YES
NO

With a Will, you can appoint an executor to administer your estate, name a guardian for your minor children, and determine who will be the beneficiaries of your estate. Your Executor is the person appointed by you or the court to administer your estate. It may be more than one person or an entity.

Executor	Alternate	Second Alternate

Living Revocable Trust*

YES
NO

While accomplishing many of the same goals as a Will, a Trust can ease the administration process of your estate by avoiding probate and can allow for more complex distribution structures. The Trustee you appoint is responsible for the administration of your trust estate according to the desires set in place by you.

Trustee	Alternate	Second Alternate

Financial Power of Attorney*

YES
NO

This document appoints an Agent to handle your affairs when you are no longer able to do so.

Agent	Alternate	Second Alternate

Health Care Power of Attorney*

YES
NO

This document appoints an Agent to make decisions concerning your health care when you are no longer able to express informed consent.

Agent	Alternate	Second Alternate

Living Will*

YES
NO

This medical directive gives your preference on intervening treatments in specific situations.

Minor Children

YES
NO

Who do you wish to serve as guardian(s) for your children (other than parents)?

First Choice	Second Choice

If you leave money to minor children, the trustees would normally manage the funds for your children through their years of development and academic training (i.e. age 21). At what age would you want the child’s share to be given outright to him/her?

ESTATE DISTRIBUTION

Below you will find three different situations. For each, please indicate what you believe would apply to you (and your spouse) for each.

1. Assuming you predecease your spouse:*

I wish to leave all my assets OUTRIGHT to my spouse if I predecease him/her (assets transfer immediately).
I have other wishes.
I am single or widowed (move to next section).

Please explain any other desires or gifts you wish to specify.

2. Assuming you are single at death:*

I wish to leave the rest of my assets OUTRIGHT to my children (or to their children if a child predeceases me).
I wish to leave assets to my children, but I have specifications concerning this.
I wish to leave specific gifts to charities at my death.
I wish to leave specific gifts to individuals (other than personal property gifts which may be given through the use of a memorandum) at my death.

Please explain the specifications you have concerning leaving money to your children.*

Please list the ministries or charities you wish to remember in your estate plan.

Ministry or Charity	State	Amount or Percentage (%)	Designation

Please list the individuals (not listed above) you wish to remember in your estate plan.

Name	Relationship	Address	Phone	Amount or Percentage (%)

3. Assuming Common Disaster (all beneficiaries predeceased), where would you want your assets to go?*

Please indicate any concerns, questions, or comments you have concerning the distribution of your estate.

NET WORTH STATEMENT

Please mark below the types of assets you own.*

Please indicate the total estimated market value of all assets checked above:*

Please indicate total long-term debt owed:*

Please sign and date digitally below, stating that the above information is true and correct to the best of your knowledge.

Name

Date

Name (Spouse)

Date