Estate Planning Intake Form

Estate Planning Intake Form
Personal Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Is Witherspoon Law permitted to text you?
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday

MonthDayYear
Date
I prefer to be contacted by:
Spouse
Are you currently legally married?
Please list your spouse’s name:

First NameLast Name
Spouse’s Birthdate

MonthDayYear
Date
Spouse’s E-mail
example@example.com
Are both you and your spouse seeking estate planning services?
Are you currently engaged to be married or believe that you are married under common law?
Do you have any prior marriages?
Please explain:
Children
Do you or your spouse have any biological or adopted children?
Child’s Full Name and Birthdate
Do you have any grandchildren?
Grandchild’s Full Name and Birthdate
Do you, your spouse, your children, or your grandchildren receive any type of government assistance? If yes, please explain:
Specific Wishes
Is there anyone you would like to specifically disinherit from your estate? (i.e., Is there a current spouse, biological or adopted child, grandchild, parent, sibling, etc. that you want “cut out of the Will?”)
If yes, please explain:
Do you have any specific items/assets you would like to leave to specific people in your Will or Trust?
If yes, please list below:
Residuary Estate

Other than specific gifts and bequests you’ve listed above, the rest of your estate will pass as part of your “residuary estate”.
Please describe how you would like your residuary estate to pass (i.e. to my spouse and then my children, etc.):
Please have your spouse describe how they would like their residuary estate to pass:
Other Professionals
Do you have an accountant, bookkeeper, or CPA you work with?
Please state the name of your accountant, bookkeeper, or CPA you work with.
Do you have a financial advisor?
Please state the name of your financial advisor.
Real Property
Do you own any real property (i.e. house, condo, or land)?
Please list the address, type (house, condo, land, etc.), and approximate value of any real property you own. Please also indicate the approximate amount owed on the house, if any:
Vehicles
Please list the make, model, and approximate value of any vehicles or boats you own and indicate if you have a loan on the vehicle:
Other Assets
Do you own any ownership or other rights in a business?
Please describe any rights or interests you have in any business(es). Include the name of the business and what percentage interest you own:
Please list any life insurance policies you or your spouse have and the beneficiaries of such policies:
Please list any investment or retirement accounts you or your spouse own as well as the beneficiaries of those accounts:
Please list any bank accounts you own (with approximate current value) and the designated beneficiaries of each account:
If you have not designated a beneficiary on these accounts with the bank, please indicate this.
End of Life Decisions
If you are declared incompetent to make your own decisions regarding your healthcare and it is determined that you will not recover from a terminal and life-altering injury or disease, and that nothing can be done to further treat, cure or otherwise fix you ailment, or you are in a fully vegetative state, you wish to (check all that apply):
If your spouse is declared incompetent to make his/her own decisions regarding their healthcare and it is determined that they will not recover from a terminal and life-altering injury or disease, and that nothing can be done to further treat, cure or otherwise fix their ailment, or they are in a fully vegetative state, they wish to (check all that apply):
At the end of my life, I wish to be an organ donor:
At the end of his/her life, my spouse wishes to be an organ donor:
Fiduciaries
An Executor's responsibilities include conducting a comprehensive inventory of the estate's assets and liabilities, paying debts and taxes, liquidating assets of the estate if necessary, and distributing the balance of the estate to its beneficiaries as directed in the Will. Please list the full name and address of an Executor for your estate:
Your Executor may be anyone you trust over the age of 18. They will be responsible for bank accounts and reporting to the Court, so choosing someone trustworthy and capable is important.
Please list the full name and address of an Executor for your spouse:
Please list the full name and address of a Successor Executor in the event your first Executor is unable to serve:
Please list the full name and address of a Successor Executor for your spouse in the event their first Executor is unable to serve:
If you have minor children, please list the full name(s) and address(es) of who you would like to be their Guardian(s) in the event that you (and their other parent) are deceased:
You may choose an individual person or a couple. You may also choose more than one individual, but this is not recommended. If you choose a couple, it is important to consider what may happen if they become divorced. Consider, instead, choosing one member of a married couple to be listed as the Guardian and knowing that, hopefully, both members of the couple will be in your child’s life. If you have more than one minor child, you may choose the same guardian(s) for all children, or select multiple different guardians.
If you have minor children, please list the full name(s) and address(es) of who you would like to be their Successor Guardian(s) in the event that you (and their other parent) and the Guardian(s) named above are deceased or unable to care for them:
A Healthcare Surrogate or Healthcare Power of Attorney makes medical decisions in the even that you are unable to do so and has access to your medical records. Please list the full name and address of someone you have chosen to be your Healthcare Surrogate or Healthcare Power of Attorney:
Please list the full name and address of someone you have chosen to be your Successor Healthcare Surrogate in the event your Healthcare Surrogate cannot serve:
Please list the names and addresses for a Healthcare Surrogate and a Successor Healthcare Surrogate for your spouse:
How did you hear about Witherspoon Law?
Anything else?
Please use the space below to share questions, comments, or anything else regarding your wishes or estate plan that you’d like us to know:
Thank you! We will be in contact shortly.

*Disclaimer: Filling out this form does not create an attorney-client relationship of any kind. Nothing in this Intake Form is, or is intended to be, legal advice.*
Should be Empty:

Estate Planning Intake Form

Personal Information

Spouse

Children

Specific Wishes

Residuary Estate

Other Professionals

Real Property

Vehicles

Other Assets

End of Life Decisions

Fiduciaries

Anything else?