ESTATE PLANNING CLIENT INTAKE FORM

Estate Planning Intake Form

For Estate Planning Documents - If married, each spouse should complete a separate form.
Name of Client / Spouse 1

PrefixFirst NameMiddle NameLast NameSuffix
(1) CLIENT's Information: This is the Estate Plan of: (Please complete in full) This person is the "CLIENT"
CLIENT's Birth Date

MonthDayYear
CLIENT's Marital Status
Optional - Name of Spouse 2 (they should fill out their own form)

PrefixFirst NameMiddle NameLast NameSuffix
Which estate plan are you looking for?
Does the CLIENT signing these documents have any children? (biological, adopted, estranged, stepchildren, pre-deceased)
HEALTH CARE POWER OF ATTORNEY

Name someone you trust to speak to your doctor if you are unable to speak for yourself. If you are able to communicate, your doctor will always follow your directions first. This document is only used if a dispute arises among others as to your treatment while unconscious. Please note if you are married, we will list the spouse first, then two alternates as named below. Available addendums for specific conditions such as dementia, or pain relief.
Name of Client's FIRST Choice for HEALTH CARE Power of Attorney (only one name required)

First NameLast Name
Name of Client's SECOND Choice for HEALTH CARE Power of Attorney

First NameLast Name
FINANCIAL POWER OF ATTORNEY

Name someone you trust to handle your money and pay for your care. You only need one, a second name is listed to step in if the first person is unable to act. Please note if you are married, we will list the spouse first, then two alternates as named below. Powers of attorney expire with you, they have no authority after death of the signer.
Name of FIRST Choice for FINANCIAL Power of Attorney

First NameLast Name
Name of SECOND Choice for FINANCIAL Power of Attorney

First NameLast Name
NAME AN EXECUTOR

After your death, you will designate someone to carry out your wishes. A Will has a named Executor, someone who has the job of following your directions and distributing your property. A Trust has a Successor Trustee, who takes over after the original grantors. Please note if you are married, we will list the spouse first, then two alternates as named below. We want the same person to be named as legal authority in both the Will and Trust, to avoid conflicts after death. If you have a Trust, you will have a "Pour Over Will" which simply states the existence of your Trust, and states that your Trust is your beneficiary under the Will.
First Choice for Executor / Successor Trustee

First NameLast Name
Second Choice for Executor / Successor Trustee

First NameLast Name
DISTRIBUTIONS AND ASSETS

What do you have, and where do you want it to go? All to Spouse, then split equally to each child? Any special provisions or restrictions? If one beneficiary predeceases you, do you want their share to go to their children or split between the other beneficiaries? Who gets the car, the boat, your pets? Adult children can take turns selecting personal items from an estate if you don't want to list everything you own. Assets are divided into: CASH, Non-CASH, and REAL ESTATE.
CASH ASSETS - Client's Cash Assets and Financial Accounts - Please list financial accounts where client's assets are held - either in cash, bonds, or stocks. Information including the number of shares, names of stocks, and account number and financial institution where funds are located - Balances are not needed.
Example "Bank of America - Checking # ending in 1234"
REAL ESTATE: List of all Real Estate or Real Property Client Owns or Holds an Ownership Interest in, either jointly, separately, or through another means. Please include full address including City, County, and State with Zip. Our office will request a certified copy of the deed to confirm the correct title for ownership.
List address, city, county, and state - include ownership information if known.
NON CASH ASSETS - CLIENT'S PERSONAL PROPERTY: (Remember, - your "stuff" includes is anything that can roll away, walk away or be stolen). Identify specific bequests, such as jewelry, a vehicle, or other identifiable asset. Military medals, photographs, antiques, anything of financial or sentimental value to you. ALSO- Specify WHEN do these gifts get distributed, either at the time of Client's passing or at the time of the Surviving Spouse's death? It is recommended that any gifts or bequests to children or beneficiaries be distributed at the death of the giver.
Document WHAT is given to WHOM and WHEN - Be specific!
ASSET DISTRIBUTION PLAN - Your Estate plan distributions can be percentages, specific items, gifts, or a general bequest. You can be as detailed as you like, please be as descriptive as possible if you own more than one of an item. A separate file can also be uploaded using the link at the bottom of this form if you wish to write out detailed instructions.
Please list all assets and the intended beneficiary - remember to identify jewelry with a description of the item.
FINAL WISHES - Disposition Instructions

Directions on Disposition of Remains/funeral preferences (cremation, joint burial plot, ashes scattered etc. Include any religious services, locations, pre-paid arrangements, or specific actions requested. Any type of funeral service or preferences are welcomed. Be as detailed or brief as you prefer. If you have already chosen a place or type of service, please include a copy of the contract for any pre-paid funeral plan.
FINAL WISHES - Please describe what services or actions should be taken with your remains. Please designate a specific person who has the right to make decisions about your remains, such as cremation, embalming, holding a funeral, etc.
Describe your preferences for any memorial services, favorite charities, and remembrances.
OPTIONAL - File Upload - Additional Information - Upload any documents or information that you want to include. You can also bring additional documents to our meetings in the office.

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DRAFT DOCUMENTS WILL BE SENT FOR REVIEW TO:

Email address

Street Address

CityState / Province

Postal / Zip Code
Name of Person Completing this Form

First NameLast Name
Should be Empty:

Estate Planning Intake Form

HEALTH CARE POWER OF ATTORNEY

FINANCIAL POWER OF ATTORNEY

NAME AN EXECUTOR

DISTRIBUTIONS AND ASSETS

FINAL WISHES - Disposition Instructions