1. Do you have a will? Yes           No          
• if yes, the will is located at                   
• if no, go to #3
  
  
2. Do you need to UPDATE your will? Yes           No          

NOTE: If any of these events have occurred since you signed your will, you should discuss updating your will with an attorney. Therefore, you should check "yes."

• Change in marital status (married, divorced, separated, widowed)
• Birth or adoption of a child
• Death of a person mentioned in your will
• Significant change in assets (purchase of home, large inheritance, etc.)



3. Do you need to MAKE a will? Yes           No          

NOTE: If any of the conditions below apply to you, you should speak with an attorney about making a will. Therefore, check "yes."

• You have minor children at home
• Your primary beneficiary is a minor
• Your estate (all assets) is valued at more than $10,000, OR
• You desire to distribute your property in a manner different than would occur under your home state law or an existing will. (For example, giving property to non-family members, limiting distribution ot certain family members, etc.)
  
  
4. Do you want to make a living will or health care power of attorney? Yes        No       
   NOTE: If you desire to limit the use of extraordinary medical procedures to prolong your life or to give someone else authority to make medical decisions for you, you should speak to an attorney about these legal documents.
   
   
5. Do you have a Power of Attorney (POA)? Yes           No          
   If YES, the POA is a (circle one) GENERAL or SPECIAL POA and it is located at:
   
   

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6. Do you want to make a POA or change your POA? Yes           No          
   NOTE: If you have previously executed a GENERAL POA or need to authorize a person to handle your bills, move your property, or handle other affairs, you should speak to an attorney about a POA.
   
   
7. If you are a SINGLE PARENT or a member of a TWO-SOLDIER FAMILY, do you have an approved Family Care Plan? Yes           No          
   
   
8. How you designate the beneficiaries of your SGLI and other life insurance can greatly affect the actual amount of money paid to your loved ones. Do you wish to speak to an attorney about your options for making this designation?
   Yes           No          
   NOTE: If any of your beneficiaries (primary or alternate) is a minor, this counseling is critical. You should check "yes" in this block. If your SGLI form says "By Law" or "By Will" it is essential that you speak with an attorney about changing these designations.
   
   
9. Are you facing any criminal or civil legal actions? Yes           No          
   If "yes", you should speak with an attorney about these matters and how deployment might affect them.
   
   
10. Do you have any other legal matters (credit/consumer problems, landlord-tenant problems, etc.) that you wish to discuss with an attorney?
Yes           No          

My signature below indicates that I have received a legal briefing covering the   areas on the form. I understand how my personal circumstances are affected by and can be   changed by these legal actions. I have been afforded the opportunity to consult with an   attorney about these matters and have used this opportunity to the degree that I feel I   need to. I am satisfied that my legal affairs are in adequate order for me to deploy.