The surviving parent of a child under the age of eighteen (18) is ordinarily
entitled to be the GUARDIAN of that child. In the case of simultaneous death of
you and your spouse, or if you are a single parent, you should appoint a
GUARDIAN for your child or children under the age of eighteen (18). It is
advisable, prior to the completion of this Questionnaire, to make sure that your
proposed GUARDIAN(S) is (are) willing to serve as GUARDIAN(S).
NOTE: An individual will be disqualified from acting as a GUARDIAN/EXECUTOR.EXECUTRIX/
PERSONAL REPRESENTATIVE if that individual is:
1. less than eighteen (18) years of age, or
2. an incompetent (judicially declared), or
3. a non-United States citizen who does not reside in
the United States, or
4. a convicted felon, or
Provide the following information about the person(s) you select to be
GUARDIAN(S). In the event my spouse predeceases me, I name as GUARDIAN(S):
1. PRIMARY Choice of GUARDIAN:
Full Name: _______________________________________
Relationship: ______________________________________
"Joint" GUARDIAN (IF YOU SO DESIRE):
Full Name: ________________________________________
Relationship: _______________________________________
2. Alternate Choice of GUARDIAN:
Full Name: ________________________________________
Relationship: _______________________________________
"Joint" ALTERNATE GUARDIAN (IF YOU SO DESIRE):
Full Name: ________________________________________
Relationship: _______________________________________
IV. ESTATE EXECUTOR (MALE) - EXECUTRIX (FEMALE) - PERSONAL REPRESENTATIVE
The person charged with administering your estate, paying taxes and/or other
debts, preserving, managing, and distributing estate assets and property is
called an Executor, Executrix, or Personal Representative.
This person should be one in whom you have complete trust and confidence
(Your spouse may be named if you so desire).
Please provide the following information about the person that you wish to
name to serve in this capacity.
1. PRIMARY Choice of Executor/Executrix/Personal Representative
(can be your spouse).
Full Name: ________________________________________
First Middle Initial Last
Relationship: __________________ 
Male
Female
Only if you wish an additional individual to serve with your primary
choice as co-executor, co-executrix, or co-personal representative then insert
that individual’s name below:
Full Name: ________________________________________
First Middle Initial Last
Relationship: ___________________
Male
Female
2. ALTERNATE Choice of Executor/Executrix/Personal
Representative.
This individual will serve in the event that either the primary or joint
executor(trix)/personal representative is not alive at the
time of your death.
Full Name: _________________________________________
First Middle Initial Last
Relationship: ____________________
Male
Female
"JOINT" ALTERNATE Executor/Executrix/Personal Representative
(if you so desire).
Full Name: ___________________________________________
First Middle Initial Last
Relationship: _____________________
Male
Female
______________________________
V. Will Provisions
Subsections A, B, C, or D, below respectively set forth the Will provisions
most customarily and usually requested by:
A. Married persons with child(ren) or grandchild(ren), or
B. Married persons with no child(ren) or grandchild(ren), or
C. Single persons with child(ren) or grandchild(ren), or
D. Single persons without child(ren) or grandchild(ren).
NOTE: CHECK ONE BOX ONLY - A, B, C, D, or E. A check mark in the box
adjacent to section A or section B or section C or section D will indicate that
you wish your property distributed precisely as indicated in all of the
subdivisions of that section.
In the event that you do not wish your property to pass exactly as set forth
in all of the subdivisions in section A or B or C or D, check the box adjacent
to section E, and indicate your plan of distribution in detail in the space
provided in section E. Add additional sheets if necessary.
A. MARRIED PERSONS WITH CHILD(REN) OR GRANDCHILD(REN).
Generally most married people provide that upon their death their property
will be distributed as follows:
1. Your estate (all property and assets not owned jointly with another
person) will be distributed to your surviving spouse, but
2. If your spouse predeceases you, then your estate will be divided in equal
shares among all of your living children, but
3. If your spouse and one or more of your children predeceases you, then that
child’s share will be distributed to his or her child(ren) in equal shares,
but
4. If your spouse and all of your children and grandchildren predecease you,
then your estate will be distributed to your living parent, or to your living
parents, but
5. Should both of your parents predecease you, then your estate will be
distributed equally to your brothers or sisters or equally to the children of a
predeceased brother or sister.
Please check A above only if you want your property distributed properly and
exactly as indicated in section A, 1 through 5, above.
NOTE: If you have checked section A above, do not check section B, C, D
or E.
B. MARRIED PERSONS WITH NO CHILD(REN) OR GRANDCHILD(REN).
Generally most married persons with no child(ren) or grandchild(ren) provide
that upon their death their property will be distributed as follows:
1. Your estate (all property and assets not owned jointly with a person) will
be distributed to your surviving spouse, but
2. If you spouse predeceases you, then your estate will be distributed to
your living parent, or equally to your living parents, but
3. Should both of your parents predecease you, then your estate will be
distributed equally to your brothers and sisters or equally to the child(ren) of
a predeceased brother or sister.
Please check B above only if you wish your property distributed properly and
exactly as indicated in section B, 1 through 3, above.
NOTE: If you have checked section B above, do not check section A, C, D
or E.
C. SINGLE PERSONS WITH CHILD(REN) OR GRANDCHILD(REN).
Generally most single persons with child(ren) or grandchild(ren) provide that
upon their death their property will be distributed as follows:
1. Your estate (all property and assets not owned jointly with another
person) will be distributed in equal shares to all of your living children, but
2. If one or more of your children predeceases you, that deceased child’s
share will be distributed to his or her child(ren), your grandchild(ren), in
equal shares, but
3. If all of your child(ren) and grandchild(ren) predecease you, then your
estate will be distributed to your living parent or equally to your parents, but
4. Should both of your parents predecease you, then your estate will be
distributed equally to your brothers and sisters or equally to the child(ren) of
a predeceased brother or sister.
Please check C above only if you wish your property distributed properly and
exactly as indicated in section C, 1 through 4, above.
NOTE: If you have checked section C above, do not check section A, B, D,
or E.
D. SINGLE PERSONS WITHOUT CHILD(REN) OR GRANDCHILD(REN).
Generally most single persons with no child(ren) or grandchild(ren) provide
that upon their death their property will be distributed as follows:
1. Your estate (all property and assets not owned jointly with another
person) will be distributed to your living parent, or equally to your parents,
but
2. Should both your parents predecease you, then your estate will be
distributed equally to your brothers and sisters or equally to the child(ren) of
a predeceased brother or sister.
Please check D above only if you wish your property distributed properly and
exactly as indicated in section D, 1 through 2, above.
NOTE: If you have checked section D above, do not check section A, B, C
or E.
E. ALTERNATE PLAN OF DISTRIBUTION
IMPORTANT
You may wish to distribute your assets in any manner you choose (your will is
a statement of your wishes and instructions); however, the following statutory
limitations and rights may apply.
In the event that you do not leave your spouse* at least one-third share
of your estate, your spouse may then, upon your death, contest the Will and
assert his or her statutory right to receive a one-third share of your
estate.
2. If you have children under the age 18 whom you named as beneficiaries of
your estate, the person’s you appoint as their Guardian will oversee your
children’s inheritance until your children reach age 18. Should you wish to
establish a trust for your children in your Will, instead of having their
inheritance placed in a Guardianship account, please indicate so below, and you
will be contacted by the Legal Plan Office.**
*A Separated Spouse retains the statutory rights set forth in Section V,
Subdivision E1 above, unless he or she has waived these rights in a separation
agreement or other document.
If, after considering all of the preceding provisions and limitations, you
choose to provide an alternative method of distribution, check E and describe
specifically and in detail, every provision which you desire to be included in
your plan of distribution. Please include the full names and relationships of
all beneficiaries. TYPE OR PRINT CLEARLY.
You may list specific gifts to individuals and/or divide your estate among
several individuals by listing percentages to each, making sure that the
percentages total 100%. You may add additional sheets if necessary.
