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<tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=hphone> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Home Phone: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=hphone><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=address> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Address: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="address" id=address><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=wphone> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Work Phone: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="wphone" id=wphone><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=city> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>City: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="city" id=city><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=fax> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Fax: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="fax" id=fax><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=state> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>State: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="state" id=state><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:3;mso-yfti-lastrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=email> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Email: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="email" id=email><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=zip> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Zip: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="zip" id=zip><o:p></o:p></span></p> </td> </tr> </table> <p> <label for=spouse> If you are married, provide your spouse's full name: </label> <span style='mso-spacerun:yes'> </span><INPUT TYPE="text" NAME="spouse" id=spouse><o:p></o:p></p> <p> <label "> If you have children, please list below: </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></p> <table class=MsoNormalTable border=0 cellpadding=0 style='mso-cellspacing:1.5pt; mso-yfti-tbllook:1184'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=childa> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>a.<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="childa" id=childa><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=Adob> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Date of Birth:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="Adob" id=Adob><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=childb> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>b.<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=childb><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=Bdob> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Date of Birth:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="Bdob" id=Bdob><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=childc> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>c.<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="childa" id=childc><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=Cdob> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Date of Birth:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=Cdob><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:3;mso-yfti-lastrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=childd> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>d.<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="childd" id=childd><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=Ddob> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Date of Birth:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="Ddob" id=Ddob><o:p></o:p></span></p> </td> </tr> </table> <p> <label for=execName> Whom do you select as Executor (and alternate) of your estate? </label> <o:p></o:p></p> <table class=MsoNormalTable border=0 cellpadding=0 style='mso-cellspacing:1.5pt; mso-yfti-tbllook:1184'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=execName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Executor Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=execRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Executor Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=execCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Executor County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=execCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Executor City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=execState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Executor State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="execName" id=execName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="execRelation" id=execRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=execCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=execCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=execState><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altExecName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altExecRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altExecCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altExecCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altExecState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:3;mso-yfti-lastrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=altExecName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altExecRelation" id=altExecRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=altExecCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altExecCity" id=altExecCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altExecState" id=altExecState><o:p></o:p></span></p> </td> </tr> </table> <p>Does the value of your estate exceed $1,000,000? <SELECT NAME="over1mil"> <OPTION>Yes <OPTION>No </SELECT><br> &nbsp;&nbsp;&nbsp;&nbsp; <label for=value> If so, what is the approximate value? </label> <span style='mso-spacerun:yes'> </span><INPUT TYPE="TEXT" id=value><o:p></o:p></p> <p> <label for=realProp> Does your estate include real property? If so, where is it located? (City, State) </label> <br> <TEXTAREA NAME="realProp" id=realProp></TEXTAREA></p> <p>If you are married, do you plan to leave your entire estate to your spouse? <SELECT NAME="leave2Spouse"> <OPTION>Yes <OPTION>No </SELECT><br> &nbsp;&nbsp;&nbsp;&nbsp; If not, please send an <span class=SpellE>adendum</span> to webform@blackburnadair.com. <o:p></o:p></p> <p> <label for=guardName> If you have minor children and survive your spouse, who do you select as Guardian (and alternate) for you minor children? </label> <o:p></o:p></p> <table class=MsoNormalTable border=0 cellpadding=0 style='mso-cellspacing:1.5pt; mso-yfti-tbllook:1184'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=guardName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Guardian Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=guardRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Guardian Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=guardCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Guardian County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=guardCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Guardian City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=guardState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Guardian State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="guardName" id=guardName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="guardRelation" id=guardRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="guardCounty" id=guardCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="TEXT" id=guardCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="guardState" id=guardState><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altGuardName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altGuardRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altGuardCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altGuardCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altGuardState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:3;mso-yfti-lastrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altGuardName" id=altGuardName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altGuardRelation" id=altGuardRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altGuardCounty" id=altGuardCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altGuardCity" id=altGuardCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altGuardState" id=altGuardState><o:p></o:p></span></p> </td> </tr> </table> <p> <label for=trustName> If you have minor children and survive your spouse, who do you select as Trustee and alternate) to manage the estate you may leave to them? </label> <span style='mso-spacerun:yes'> </span><o:p></o:p></p> <table class=MsoNormalTable border=0 cellpadding=0 style='mso-cellspacing:1.5pt; mso-yfti-tbllook:1184'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=trustName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Trustee Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=trustRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Trustee Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=trustCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Trustee County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=trustCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Trustee City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=trustState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Trustee State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="trustName" id=trustName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="trustRelation" id=trustRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="trustCounty" id=trustCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="trustCity" id=trustCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="trustState" id=trustState><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altTrustName> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Name:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altTrustRelation> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt Relation:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altTrustCounty> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt County:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altTrustCity> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt City:<o:p></o:p></span></p> </label> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <label for=altTrustState> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>Alt State:<o:p></o:p></span></p> </label> </td> </tr> <tr style='mso-yfti-irow:3;mso-yfti-lastrow:yes'> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altTrustName" id=altTrustName><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altTrustRelation" id=altTrustRelation><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altTrustCounty" id=altTrustCounty><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altTrustCity" id=altTrustCity><o:p></o:p></span></p> </td> <td style='padding:.75pt .75pt .75pt .75pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><INPUT TYPE="text" NAME="altTrustState" id=altTrustState><o:p></o:p></span></p> </td> </tr> </table> <p> <label for=distAge> Assuming trust funds are established for minor children, at what age (or ages) do you wish the trust funds to be distributed? </label> <br> <INPUT TYPE="text" NAME="distAge" id=distAge><o:p></o:p></p> <p> <label for=noSurvivorsDist> In the event you do not have a spouse or children, or you survive both your spouse and children, how do you want your property distributed? </label> <br> <TEXTAREA NAME="noSurvivorsDist" id=noSurvivorsDist></TEXTAREA><o:p></o:p></p> <p> <label for=manageFinances> Who do you select as agent (and alternate) to manage your finances if you are incapacitated and what is their relationship to you? </label> <br> <TEXTAREA NAME="manageFinances" id=manageFinances></TEXTAREA><o:p></o:p></p> <p> <label for=manageHealth> Who do you select as agent (and alternate) to make healthcare decisions if you are incapacitated and what is their relationship to you? </label> <br> <TEXTAREA NAME="manageHealth" id=manageHealth></TEXTAREA></p> <p><INPUT TYPE="submit" ACTION="mail.php" METHOD="POST" NAME="button"><INPUT TYPE="reset"></p> <p class=MsoNormal style='margin-left:23.0pt'><span style='font-size:24.0pt; color:#A6A6A6;mso-themecolor:background1;mso-themeshade:166;mso-style-textfill-fill-color: #A6A6A6;mso-style-textfill-fill-themecolor:background1;mso-style-textfill-fill-alpha: 100.0%;mso-style-textfill-fill-colortransforms:lumm=65000'><a href="http://www.blackburnadair.com/Links.html"><span style='color:#A6A6A6; mso-themecolor:background1;mso-themeshade:166;mso-style-textfill-fill-color: #A6A6A6;mso-style-textfill-fill-themecolor:background1;mso-style-textfill-fill-alpha: 100.0%;mso-style-textfill-fill-colortransforms:lumm=65000'>Back</span></a><o:p></o:p></span></p> <p><o:p>&nbsp;</o:p></p> </form> </div> </body> </html>