Derek Cordier, Esquire
                           LAW OFFICE
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319 South Front Street
Harrisburg, PA 17104

 Phone: 717 919-4002 
 Fax: (717) 230-1931

The Prices of the documents include unlimited telephone and email conferencing with attorney Cordier directly. It is recommended that a telephone conference take place while the Client fills out the form.

PLEASE READ: “Why A Will Is A Must” prior to filling out the form.

Once this form is provided to the Office, you will receive a draft for review. Changes may be made at any time prior to signing. Unless you are within driving distance of the Office, you will need to have all of the Documents notarized and witnessed by two persons not named in any of the documents. Once notarized and signed, copies must be returned to the Office for safekeeping. The Client will keep the Originals.

PLEASE NOTE: Remember, any asset that has a “Beneficiary Designation” falls outside of the Will and the beneficiary must be correctly stated with the specific asset. This includes life insurance, pensions, bank accounts, etc.

BENEFICIARIES: Specify; full name, relationship, natural, adopted, or step-child/children, and age. (If there is more than one beneficiary in each step, please state the percentage of your estate you wish to go to each beneficiary). Example: All to Mary as first beneficiary in step #1. If Mary does not survive me by 30 days, then John (50%) and Jim (50%) to split as beneficiaries in step #2. Using percentages is a much safer way to distribute assets than giving a lump sum, due to the possibility there may or may not be a lump sum to distribute.

If you have multiple beneficiaries listed and one or more of them die before you, do you want their share to go to the surviving beneficiaries (The others you have named), or to their heirs. Example: On line 1) you name John, Susan, and Dan. If John passes first, do you want his share to go to Susan and Dan or to John’s heirs.

Full Legal Name:
Telephone Number:
Emergency Telephone Number:

Step 1: Upon my death, all of my property shall go first to:

Step 2: If the person or persons named in Step 1) does/do not me then to all of my property second to: 
Step 3: If the persons named in Step 1) and Step 2) do not survive me then to: 
If Multiple Beneficiaries, please choose either surviving or heirs:
PERSONAL REPRESENTATIVE: The Executor or person who will take inventory of all the assets and then distribute them according to the wishes stated in your Will. 

You may also choose both surviving and heirs, for different beneficiaries. If both please specify: 
​If the person named above is unable or unwilling to serve?
Successor Personal Representative's Full Legal Name: 

Personal Representative's Full Legal Name:

SPECIFIC GIFTS:  If you have specific property you wish to go to a specific person, please discuss your options with Attorney Cordier during your first conference.
REMAINS: Your next of kin has first rights to your remains unless you specify otherwise in writing.  For LGBTs our usual language  is "Partner has full rights and control of my remains, ashes, and any funeral and/or memorial arrangements."
I wish to donate my organs:
I wish to be cremated:
If you have other specific funeral / memorial wishes, please specify: