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    CLIENT INFORMATION

    [Strictly Confidential]

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  • PERSONAL REPRESENTATIVE OR TRUSTEE

    The name of the person(s) that you want to be the decision maker concerning your estate upon your death:

  • GUARDIAN FOR MINOR CHILDREN

    The name of the person(s) that you want to raise a child that is under 18 (if applicable):

  • HEALTH CARE AGENT

    The name of the person(s) that you want to make any major medical decisions on your behalf:

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  • AGENT—POWER OF ATTORNEY FOR FINANCES & PROPERTY

    The name of the person(s) that you want to make financial decisions on your behalf if you are incapacitated:

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  • BURIAL WISHES

  • ESTIMATED* VALUE OF ESTATE


    TYPE OF ASSET:                                                                                                     ESTIMATED VALUE

  • Address of each piece of real estate:


    Property #1:

  • Property #2:

  • Property #3:

  • PLEASE ATTACH COPIES OF ANY DEEDS YOU HAVE READILY AVAILABLE FOR REAL ESTATE WHEN YOU RETURN THIS FORM. THANK YOU!

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  • * Use best guess; this can be a “ballpark” estimate.


    ** Do not show benefits which will terminate at death (e.g., pension, social security, etc.).
         Value of Life Insurance policies will be listed separately on the next page.

  • LIFE INSURANCE
    (do not include accidental death policies)


    • "Cash Value" use best estimate (term policies normally have no cash value)
    • "Face Value" is the amount payable at death

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  • Instructions Regarding Real Estate Deeds and Other Paperwork:


    When returning this document, please attach copies of any deeds for real property that you have readily available. If you do not have the deeds available when you return the questionnaire you may also bring this paperwork with you to the initial consultation. If you do not have the deeds available, please make a note and I can search for them online if necessary for a small fee. Please feel free to attach bank statements, investment account statements, titles, or paperwork concerning other valuable assets that you believe would be useful to me when returning this document. Thank you for completing this questionnaire and for working with me to make your initial consultation as efficient and effective as possible!

     

    Scheduling Your Estate Planning Design Meeting:


    When you have completed this questionnaire and returned it to my office, please contact the office by email at attorney@theburtonlawoffice.com to schedule an appointment for your initial consultation where we will review your questionnaire and design a custom estate plan designed to fit your needs. Clients who return the questionnaire first will receive first priority in scheduling available appointments. Thank you for your understanding and cooperation!

     

    Instructions for Returning Completed Estate Planning Questionnaire:

    Email or online electronic submission is the preferred method for receiving the completed questionnaire. If you are filling this form out via JotForm, please save a copy to your own computer for future reference, then when you are finished click "Submit" at the bottom of the form. You can also click "Print Form" and bring a printed copy of your completed questionnaire with you to your Estate Planning Design Meeting for reference during our meeting. Finally, if you have additional attachments to include, please send them separately by email to attorney@theburtonlawoffice.com.

    If you complete this form and wish to send it to our office via email, please send in PDF format to:

    attorney@theburtonlawoffice.com

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