Estate Intake Form

Gilman Estate Planning - Intake Form

If you would prefer not to complete the form you can answer questions by calling Brett Gilman at 530-343-4318.
Name (how it appears on your passport, state identification or driver's license) *

First Name Middle Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Date of Birth *

Month Day Year
Date
US Citizen *

Yes No

General Information

Client's Spouse
Spouse's Name (how it appears on your passport, state identification or driver's license)

First Name Middle Name Last Name
Spouse's Email
example@example.com
Spouse's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Spouse's Phone Number

Area Code Phone Number
Spouse's Date of Birth

Month Day Year
Date
US Citizen

Yes No

Number of Biological or Legally Adopted Children (for client): *
List each child (full legal name), date of birth, address, phone number (home and mobile), and name of other parent.
Number of Client's Spouse's Children that are not biological/adopted by Client:
List each child (full legal name) of client's spouse, date of birth, address, phone number (home and mobile), and name of other parent.
Are there any stepchildren or foster children who you want treated as if they were your legal children?

Yes No
For each step/foster child you want treated as a legal child, provide full legal name, date of birth, address, phone number (home and mobile).

Assets
What assets do you own that need to be in the trust? (Do not include all vehicles, household items, jewelry, tools, yard and garage items as these items be generally assigned to the trust and DO NOT need to be specifically listed. Any collectables and art with a value over $10,000 each, may be listed.)
Address of Real Property (copy of current deed will be required)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
File Upload - Copy of Current Deed of Real Property

Browse Files

Cancel of
Address of 2nd Real Property (copy of current deed will be required)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
File Upload - Copy of 2nd Real Property Current Deed

Browse Files

Cancel of
Banking - Provide Name of Bank Accounts and Type of Account (Checking,Savings, Certificate of Deposit) and approximately how much is usually kept in the account. Account Numbers are NOT needed.
Stocks, Bonds, and Investment Accounts - Provide Name of Institution Holding and Estimated Value. Account Numbers and NOT needed.

Do you own a business?

Yes No
Provide the type of business (Sole Proprietorship, Corporation, Limited Liability Corporation, Partnership) and the estimated value of the business.
List any Equipment, Machinery, or Livestock:
Any Employee-Owned Company Stock, Structured Settlements, Annuities, Promissory Notes owed to client/spouse:
Do you have Life Insurance?

Yes No

Distribution

Upon your passing, how do you want your estate distributed?
Provide a short description of what you want to happen to your estate after you have passed. Any specific gifts of money, property, or personal items? Keep in mind the following: What if a beneficiary predeceases you, such as a child dies but leaves grandchildren, do you want that deceased child's share to go to the grandchildren? Do we need to keep your estate in trust for a child under the age of 25? Are there family members that you want to prohibit from getting any of your estate?
Are any children or beneficiaries disabled or receiving disability?

Yes No
If yes, what type of disability payment are they receiving?

People In Charge
People in Charge of Will and Trust - Provide name, address, phone number, and email (optional) of who will be in charge of your Will and Trust:
Alternate People in Charge of Will and Trust - Provide name, address, phone number, and email (optional) for the alternate people in charge of your Will and Trust (#1, #2, #3)
People in Charge of Durable Power of Attorney for Property Management - Provide name, address, phone number, and email (optional) of who will be in charge of your property management:
Alternate People in Charge of Durable Power of Attorney for Property Management - Provide name, address, phone number, and email (optional) for the alternate people in charge of your Durable Power of Attorney for Property Management (#1, #2, #3)
People in Charge of Advanced Health Care Directive to make health and medical decisions - Provide name, address, phone number, and email (optional) of who will be in charge of your health and medical decisions:
Alternate People in Charge of Advanced Health Care Directive - Provide name, address, phone number, and email (optional) for the alternate people in charge of your health and medical decisions (#1, #2, #3)
Nomination of Guardian of Minor Children - if any children under the age of 18, provide a nominated guardian for custody and care of child/children until they reach the age of 18. Provide name, address, phone number and email (optional):
Alternate Nomination of Guardian of Minor Children - if any children under the age of 18, provide alternate nominated guardians for custody and care of child/children until they reach the age of 18. Provide name, address, phone number and email (optional):
For your Advanced Health Care Directive, what are your burial wishes:

Burial Cremation
Are you a body part donor? Anatomical gifts?

Yes No
If you are in a vegetative state or irreversible coma, do you want them to 'pull the plug'?

Yes No

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