The Law Office of Amy Zapatka, LLC ATTORNEY AT LAW 140 S. Cherokee Road POST OFFICE BOX 1455 SOCIAL CIRCLE, GEORGIA 30025 ____ Telephone 470/333-0022 Fax 470/333-0044 LAST WILL AND TESTAMENT WORKSHEET FULL NAME: ____________________________________ Last 4 digits SS#: ________ ADDRESS: ______________________________________ DOB: __________________ CITY, STATE & ZIP: ______________________________ COUNTY: ______________ HOME PHONE: _______________________ CELL PHONE:_______________________ WORK PHONE: _______________________ E-MAIL: ____________________________ MARITAL STATUS: Single Married Divorced Widowed SPOUSE’S NAME: ___________________________________________________________ CHILDREN: __________________________________________________________________ natural and/ __________________________________________________________________ or adopted __________________________________________________________________ EXECUTOR: __________________________ RELATIONSHIP:____________________ SUCCESSOR: _________________________ RELATIONSHIP: ____________________ TRUSTEE: ____________________________ RELATIONSHIP: ____________________ SUCCESSOR: _________________________ RELATIONSHIP: ____________________ BENEFICIARIES: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ TERMS OF TRUST: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ SPECIAL BEQUESTS: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________
