Wills, Power of Attorney

Our office can assist you with drafting Wills and Powers of Attorney.  If you are interested in these services, please call the office and we would be glad to assist.  For your convenience, if you are interested in having a simple will drafted, please follow the directions below:

**If you are interested in making your will, please print out this page, fill it out and submit it to this office by following the instructions at the end.**

The Law Office of Andrew D. Brockway, LLC

Simple Will Intake Form

Personal Information:

Your full name:                        ________________________________
Your address:                          ________________________________
Phone number: ________________________________
Marital Status:                         Married___________  Single_________
Your email address:                ________________________________

Spouse's Information:

Full name:                               ____________________________________
Address:                                 ____________________________________

**If you are not married, please list the names and addresses of the persons or charitable organizations that you want to receive your assets upon your death:


Marital Information:                                                                                                                                                          Have you ever divorced?                    Yes______  No_____

Your Dependents:

Name: ___________________________  Age:______
Name: ___________________________  Age:______
Name: ___________________________  Age:______
Name: ___________________________  Age:______
Name: ___________________________  Age:______

**If your children are minors (under 18 years), then please state the name and address of the individual(s) you would like to recommend for guardianship (i.e. to care for your children).  Please name at least two alternates: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**If one of your children is a minor when you die, do you want that child’s inheritance to go into a simple trust to prevent the minor child from spending the inheritance until he or she is 18 years_____, 21 years _____ or 25 years_____?

**If one of your children or beneficiary (ies) dies before you, do you want his or her share(s) of your estate to go to your other living children?  [Yes___; No___]?


Do you want your deceased child’s share of your estate to go to his or her issue (i.e. children/grandchildren of that deceased child) [Yes____; No____]?

Specific Bequests:  Do you want to make any specific bequests? (i.e. my wedding ring to daughter or my gold watch to my nephew)  If so, then state:

Item & Full Name of Person: __________________________________________________________

Item & Full Name of Person: __________________________________________________________

Item & Full Name of Person: __________________________________________________________

Item & Full Name of Person: __________________________________________________________

  Do you want to exclude any individual from your will?  Yes____; No_____.  If yes, then state the Full Name of Each Person(s) to be disinherited:

**Do you want to disinherit an individual if he or she contests your will?
Yes____; No____

  Who do you want to be your Executor [the person that would administer your will]?  In most cases, this will be your spouse.  If spouse, check here ____.

If some other person(s), then state the full name and address of person(s) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**Please provide name and address of Alternate Executor to be appointed in case the person that you have named Executor is unable or unwilling to perform the duties: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Burial Requests
:  Do you have any special requests for your funeral or burial?  Yes____; No____

Specific Cemetery: _____________________________________________

Specific Directions for your funeral: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Cremation:  Yes_____; No______

Living Will/Durable Healthcare Proxy and Power of Attorney: 
Are you interested in a Power of Attorney, Living Will [Do No Resuscitate Order] or Durable Healthcare Proxy [allows a person to make decisions concerning your healthcare if you cannot]?       Yes_____; No_____

If yes, then please state the name, address and telephone number of the person you would like to name as your Power of Attorney: __________________________________________________________________________________________________________________________________________________________________________

Please indicate name, address, and telephone number of Alternate Person to Act: __________________________________________________________________________________________________________________________________________________________________________

Please mail your form to: 

The Law Office of Andrew D. Brockway, LLC

Attn: Andrew Brockway, Esq.

121 Bridge Street

Plattsburgh, N.Y. 12901

You may also email your form to kim@cctlaw.com or fax it to 518-563-5845.

When your Last Will & Testament is ready, our office will contact you to schedule an appointment.  Thank you.

The Law Office of Andrew D. Brockway
121 Bridge Street Plattsburgh, NY 12901 US
Phone: 5185657595 Website: www.plattsburghattorney.com
Website Builder