Estate Planning Packet 1

G RANT L AW P ARTNERS
A TTORNEYS AT L AW
123 NORTH APOPKA AVENUE 5775 EAST COUNTY ROAD 462
INVERNESS, FLORIDA 34450 WILDWOOD, FLORIDA 34785
WILLIAM J. GRANT TELEPHONE

TAYLOR F. FORD (352) 726-5111
FRED D. MONGELLO FACSIMILE
(352) 726-7244
CHRISTOPHER A. BLAISDELL
ESTATE PLANNING PACKET
Last Will & Testament
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
City: __________________________________ State: ______________________ Zip Code: _________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Personal Representative’s Name: _________________________________________________________
Alternative Personal Representative’s _________________________________________________________

Name:
Would you like to include in your Will how you would

like your remains to be cared for? □ Yes or □ No
If yes, ________________________________________________
Please advise if you would like a burial to advise of the
location.
Or if you would like to be cremated, please advise ________________________________________________
whom shall receive possession of your remains.
Would you like to specifically devise your assets?
□ Yes or □ No
If no, all assets will be divided in the Residue Clause in ________________________________________________
your Will. Please advise what percentage you would ________________________________________________
like your assets to be divided between your ________________________________________________
beneficiaries. (If equally divided do NOT fill out) ________________________________________________
________________________________________________
If yes, please list which asset you would like to leave ________________________________________________
for which beneficiary. ________________________________________________
________________________________________________
________________________________________________
________________________________________________
PLEASE RETURN TO GRANT LAW PARTNERS Page 1 of 4

List of Beneficiaries / Heirs
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
City: ______________________________ State: ____________________ Zip Code: _________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Full Legal Name: ________________________________________________________________________
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Power of Attorney
Full Legal Name of ________________________________________________________________________

First Choice:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Second/Alternative:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Health Care Surrogate

First Choice:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Second/Alternative:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Living Will

First Choice:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Second/Alternative:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________
Pre-Needed
Guardianship
First Choice:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

Second/Alternative:
Address: ________________________________________________________________________
D/O/B _______/_____/__________ SSN: _____________-________-_____________

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G RANT L AW P ARTNERS

WILLIAM J. GRANT TELEPHONE

Full Legal Name: ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Personal Representative’s Name: _________________________________________________________

Alternative Personal Representative’s _________________________________________________________

Would you like to include in your Will how you would

PLEASE RETURN TO GRANT LAW PARTNERS Page 1 of 4

Full Legal Name: ________________________________________________________________________

City: ______________________________ State: ____________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name: ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name: ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name: ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name: ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

PLEASE RETURN TO GRANT LAW PARTNERS Page 2 of 4

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Health Care Surrogate

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

PLEASE RETURN TO GRANT LAW PARTNERS Page 3 of 4

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

Full Legal Name of ________________________________________________________________________

City: __________________________________ State: ______________________ Zip Code: _________

D/O/B _______/_____/__________ SSN: _____________-________-_____________

PLEASE RETURN TO GRANT LAW PARTNERS Page 4 of 4

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