Legalgen - Power Of Attorney - Questionnaire

Registration Info
Please use your legal name as it appears on your license or government-issue ID

Get started, provide your information below and provide your Child's info on the next page

First Name *

Middle Name

Last Name *

Email *

Password *

Cell *

Your Contact Details
Your Contact Details

Name:

Date Of Birth *

Also known as(optional)

Are you married? *

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Yes

✓

No

Suffix(optional)

✓

Jr

✓

Sr

✓

II

✓

III

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Other

Gender

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Male

✓

Female

Your Address

Full Address: *

Address Line 1 *

Address Line 2

City *

State *

County *

Zip Code *

Is Your mailing address the same as your home address? *

✓

Yes

✓

No

Your Spouse Information
Please use your legal name as it appears on your license or government-issue ID

Your spouse's Details

First Name: *

Middle Name *

Last Name: *

Email *

Date Of Birth *

Cell *

Suffix(optional) *

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

Please select "Suffix(optional)".

Also known as(optional)

Gender

✓

Male

✓

Female

Is Your spouse's address different than you? *

✓

Yes

✓

No

State: *

Executor
The Executor is the person who administers the estate. Its common to have the same person be the Executor and Trustee" our Spouse will be your default Executor. You can name an alternative trustee should you spouse or primary trustee not survive and you can overwrite primary Executor.

Please name at least one or more individuals who will serve as the Personal Representative of your last will & testament:

Primary Executor *

Executor - Spouse/Partner
The Executor is the person who administers the estate. Its common to have the same person be the Executor and Trustee" our Spouse will be your default Executor. You can name an alternative trustee should you spouse or primary trustee not survive and you can overwrite primary Executor.

Primary Executor *

Financial DPOA:
Name someone (agents) you trust to make financial decisions on your behalf in the event you are unable to do so yourself.

Provide the information of one or more individuals who will serve as your agent under the Durable Power of Attorney:

Do you want to use the same agents as your personal representative? *

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Address *

Financial DPOA-Spouse/Partner
Name someone (agents) you trust to make financial decisions on your behalf in the event you are unable to do so yourself.

Primary Agent: *

Phone Number *

Address *

Health Care POA
Name someone (agents) to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Financial Durable POA? *

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Address *

Health Care POA - Spouse/Partner
Name someone (agents) to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Power of Attorney? *

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Address *

Summary
Summary

If you would like to review your responses, please review your responses on the right hand side on the specific screens. After you click submit, you will be finished and we will email your answer and the office will contact you with the next steps .

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