Nebraska Life Documents Planning Package

Nebraska Life Documents Planning Questionnaire

This questionnaire is designed to help you gather the necessary information for preparing your Nebraska Life Documents, including your Last Will and Testament, Powers of Attorney, and Living Will. Please fill out the sections below to the best of your ability.

I. Personal Information

Full Legal Name: Date of Birth:

Current Address:

Phone Number: Email Address:

Marital Status: Spouse's Full Name (if applicable):

II. Family Information

Children's Names and Dates of Birth (if applicable):

Other Dependents (Name, Relationship, DOB):

III. Last Will and Testament

Primary Executor Name: Alternate Executor Name:

Guardian for Minor Children (if applicable):

Specific Bequests (who gets what specific item):

Residuary Beneficiaries (who gets the rest of your estate):

IV. Powers of Attorney

Agent for Property/Finances: Alternate Agent for Property/Finances:

Agent for Health Care: Alternate Agent for Health Care:

Specific wishes or limitations for Health Care Agent:

V. Living Will / Declaration

Your desires regarding life-sustaining treatment if you are unable to make decisions (e.g., withhold/withdraw treatment, provide comfort care only):

VI. Financial Information (Summary)

Major Assets (e.g., Real Estate, Bank Accounts, Investments, Vehicles):

Major Liabilities (e.g., Mortgages, Loans, Credit Card Debt):

VII. Document Storage

Where do you plan to store your completed legal documents?

VIII. Acknowledgment and Signature

By submitting this form, I acknowledge that the information provided is accurate to the best of my knowledge and will be used to prepare my life documents.