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Prepared by Norman Pickell, a will
and power of attorney lawyer based in Goderich, Ontario.
Please complete as much of this Form as possible by printing your
answers. Make sure that you have completed the
General
Information for Wills and Powers of Attorney Form.
Name: _________________________________
Date: ___________
Do you already have a will?
Yes ________ No _______
If Yes, what year was it
done? __________
If Yes, where is it? ______________________________________________
Have you pre-arranged your funeral? Yes _____ No _____
(If you want to learn more about funerals - including pre-arranging, please click
here.)
If you have pre-arranged your funeral, what is the name and address of the
funeral home?
_____________________________________________________________
If you have not pre-arranged your funeral, do you have any special
instructions that you want in your will?
No _____ Yes _____ If Yes, details ______________________________
____________________________________________________________
____________________________________________________________
Do you wish to donate any of your organs to be used for organ transplants?
(If you want to learn more about organ and tissue donations, please click
here.)
Yes ____ No ____ Not right now ____ Not sure ____
Other comments ______________________________________________
A. Estate Trustees (formerly known as
"Executors"):
(Your Estate Trustee is the person who gathers in your assets, pays your
bills and distributes your money and other assets to your beneficiaries in
accordance with your will. This person can be your spouse, some or all of your
children (provided they are at least 18 years old), a trust company, or someone
else in whom you have confidence. You can have more than one Estate
Trustee.
(If you want to learn more about the Duties of an Estate Trustee, please click
here.)
A.1 Who do you want to be your Estate Trustee?
Your spouse alone Yes _____ No _____
Your spouse together with the following named
Yes _____ No _____
Only the following named: Yes _______ No _______
Name(s), address, relationship to you and telephone number for each:
1. ___________________________________________________________
_____________________________________________________________
2. ___________________________________________________________
_____________________________________________________________
3. ___________________________________________________________
_____________________________________________________________
4. ___________________________________________________________
_____________________________________________________________
A.2 Who do you want to be the alternate Estate
Trustee(s) in the event that something happens to the person(s) you
have just named above to be your Estate Trustee (such as that person dies, has a
stroke, or just does not want the responsibility)?
Name(s), address, relationship to you and telephone number for each:
1. ____________________________________________________________
______________________________________________________________
2. ____________________________________________________________
______________________________________________________________
3. ____________________________________________________________
______________________________________________________________
4. ____________________________________________________________
______________________________________________________________
A.3 Who do you want to be the further alternate Estate Trustee(s) in the
event that something happens to the person(s) you have just named above to be
your Estate Trustee (such as that person dies, has a stroke, or just does not
want the responsibility)?
Name(s), address, relationship to you and telephone number for each:
1. ____________________________________________________________
______________________________________________________________
2. ____________________________________________________________
______________________________________________________________
3. ____________________________________________________________
______________________________________________________________
B. Beneficiaries:
When you die, how do you want your estate distributed?
B.1 IF YOU HAVE A SPOUSE, complete this Section:
(if you do not have a spouse, please skip this section and go to B.2)
B.1.a) Even while your spouse is still alive, are there any particular
assets, such as a piece of jewellery or an item of special furniture, to go to
someone other than your spouse?
No _____ Yes ______
If Yes, are you going to prepare a list to be kept somewhere?
Yes _____ No
______
If Yes, where will it be?
with your original will _________
in your safety deposit box _________
in special place at home ____________________________
If No, do you want the items and the persons listed in your will?
Yes _____
No ______
If you do, name of person(s) and particular asset(s):
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
(if more than 4 items, please list the names and the items on a separate
piece of paper)
B.1.b) Even while your spouse is still alive, are there any charities to
which you want to leave money?
(If you want to find out more about charities, please click
here.)
Yes ______ No ______ Not right now _______
If Yes, name of each charity and amount to be given:
1. ____________________________________________________________
2. ____________________________________________________________
3. ____________________________________________________________
4. ____________________________________________________________
(if more than 4 charities, please list the names and amounts on a separate
piece of paper)
B.1.c) Does everything else in your estate go to your spouse
upon your death?
Yes _____ No _____
If No, details ____________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
B.1.d) For the part of your estate which goes to your Spouse are there
any restrictions?
No ______ Yes _______
If Yes, details ____________________________________________________
________________________________________________________________
________________________________________________________________
B.2 IF YOU DO NOT HAVE A SPOUSE, or in the event that your SPOUSE
DIES BEFORE YOU, complete this Section:
B.2.a) Are there any particular assets, such as a piece of jewellery or
an item of special furniture, to go to someone?
If Yes, are you going to prepare a list to be kept somewhere
Yes _____ No
______
If Yes, where will it be?
with your original will _________
in your safety deposit box _________
in special place at home ____________________________
If No, do you want the items and the persons listed in your will?
Yes ___
No ___
If Yes, name of person(s) and particular asset(s):
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
(if more than 4 items, please list the names and the items on a separate
piece of paper)
B.2.b) Are there any charities to which you want to leave money?
(If you want to find out more about charities, please click
here.)
Yes ______ No ______ Not right now _______
If Yes, name of each charity and amount to be given:
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
(if more than 4 charities, please list the names and amounts on a separate
piece of paper)
B.2.c) If you do not have a spouse, or in the event that you
spouse dies before you do, what is to happen to the balance of your
estate?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
B.3 This Section is to be completed by everyone:
Your lawyer needs to know how you want your estate distributed if some or all
of the persons mentioned in B.1 or B.2 die before you do?
B.3.a) Are there any particular assets (not already listed under this
category in B.1 or B.2), such as a piece of jewellery or an item of special
furniture, to go to someone?
No _____ Yes ______
If Yes, are you going to prepare a list to be kept somewhere?
Yes ____ No ____
If Yes, where will it be?
with your original will _________
in your safety deposit box _________
in special place at home ____________________________
If No, do you want the items and the persons listed in your will
Yes ____
No ____
If Yes, name of person(s) and particular asset(s):
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
(if more than 4 items, please list the names and the items on a separate
piece of paper)
B.3.b) Are there any particular charities to which you want to leave
money?
(If you want to find out more about charities, please click
here.)
Yes ______ No ______
If Yes, name of each charity and amount to be given:
1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________
4. ___________________________________________________________
(if more than 4 charities, please list the names and amounts on a separate
piece of paper)
B.3.c) If someone that you have named in Sections B.1 or B.2 dies before
you do, what is to happen to the bequest that you were intending to give to
that person?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
B.4 This Section is to be completed only if you have a beneficiary
who is under 18 years of age or you have a beneficiary over
18 but you want that person to have to wait until a later age
to receive the money from your estate:
B.4.a) What age do you want the beneficiary to be before that person
receives the money from your estate "without any strings attached"?
18 ____ 21 _____ 25 _____ 30 ____ other _______
B.4.b) Do you want your Estate Trustee to be able to pay out some of the
capital from the under-age beneficiary's share to or for the benefit of that
beneficiary if the money is needed for such things as dental bills, medical care
or education?
Yes ______ No _____
B.4.c) If the under-age beneficiary survives you, but dies before
reaching the age you specify that the person can have the money "without
any strings attached," what do you want to have done with the balance of
that person's share?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
B.5 This Section to be completed only by those with Children Under 18:
Who is to be the Guardian of any children you have who are under 18
years of age at your death?
Name and Address of Guardian(s) (include relationship to you):
_____________________________________________________________
_____________________________________________________________
B.6 This Section to be completed by Everyone:
Are any of your beneficiaries challenged physically or mentally or receiving
any type of Government financial assistance (for a disability or otherwise)?
No ___ Yes ___
If Yes, details _________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
This is NOT A WILL. These are INSTRUCTIONS ONLY. When you have completed this
Form as much as you can, please mail this Form (together with the General
Information Form) to your Lawyer, or take them to your FIRST Interview with your
lawyer.
What you have printed in these Instructions will NOT become part of your Will
until it has been prepared by your lawyer AND you have signed your Will.
Your lawyer will review these Instructions and include in your Will the
appropriate powers to be given to your Estate Trustee(s).
_________________________________
Signature of person completing this form
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