Estate Planning Intake Form
Please complete the secure form below. Once you have completed this form you will be asked to schedule a time that works for you to go over your information.
PERSONAL INFORMATION
YOUR FULL NAME
*
First Name
Middle Name
Last Name
YOUR EMAIL ADDRESS
*
example@example.com
YOUR PHONE NUMBER
*
YOUR BIRTHDATE
-
Month
-
Day
Year
Date
ARE YOU A US CITIZEN?
YES
NO
YOUR OCCUPATION
YOUR YEARLY INCOME
SPOUSE / PARTNER INFORMATION
If applicable, please provide the following information.
SPOUSE / PARTNER FULL NAME
First Name
Middle Name
Last Name
SPOUSE / PARTNER EMAIL ADDRESS
example@example.com
SPOUSE / PARTNER PHONE NUMBER
SPOUSE / PARTNER BIRTHDATE
-
Month
-
Day
Year
Date
IS SPOUSE / PARTNER A US CITIZEN?
YES
NO
SPOUSE / PARTNER OCCUPATION
SPOUSE / PARTNER YEARLY INCOME
YOUR ADDRESS
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
MARITAL STATUS: Please include date of marriage and a prenuptial agreement.
PREVIOUS MARRIAGES: Do you have a prenuptial agreement?
Please also indicate any previous marriages, and whether ended in death or divorce.
WHAT ASSETS DO YOU OWN?
Please give “ballpark” values. Please indicate financial institution, but no need for acct no.
RETIREMENT ACCOUNTS: Provide Who is the beneficiary?
LIFE INSURANCE: Provide On whose life? Who is the beneficiary?
REAL ESTATE: Provide Coop? Condo? Owned Jointly? In Corporation? In Trust?
CASH ACCOUNTS: Provide Owned Jointly? In Corporation? In Trust?
OTHER INVESTMENTS: Provide Owned Jointly? In Corporation? In Trust?
BUS / INTEL PROPERTY: Provide Owned Jointly? In Corporation? In Trust?
WHO ARE YOU CLOSEST LIVING RELATIVES?
Please include people from whom you are estranged. If this is too complicated to describe here, we can discuss in person.
CHILDREN: Include those adopted or born out of wedlock. (One per row)
PARENTS: Include adoptive parents, but not stepparents. (One per row)
SIBLINGS: Include half-siblings, but not step-siblings. (One per row)
WHO SHOULD HANDLE YOUR AFFAIRS?
Please provide all contact information, either here, or in separate page or email.
EXECUTOR: Primary
In charge of settling your estate after your death.
EXEC-ALTERNATE(S): (0ne per row)
POWER OF ATTORNEY: Primary
Able to handle your personal business during your life in the event of incapacity or other circumstances.
PoA-ALTERNATE(S): (0ne per row)
HEALTH CARE PROXY: Primary
Makes medical decisions for you if you are unable to make them for yourself.
HCP-ALTERNATE(S): (0ne per row)
GUARIDAN: Primary
Would have custody of your children if you are deceased or incapacitated.
GDN-ALTERNATE(S): (0ne per row)
WHO WOULD YOU LIKE TO RECEIVE YOUR ESTATE?
Note that the disposition of specific items of personal property, and electronic files, can be directed in a separate memorandum, rather than in your will.
DO YOU HAVE ANY HEALTH ISSUES?
FUNERAL / BURIAL WISHES:
SPECIAL CIRCUMSTANCES OR CONCERNS?
HOW DID YOU HEAR ABOUT US?
Could you please let us know how you heard about us
HOW DID YOU HEAR ABOUT US?
PLEASE ELABORATE
UPLOAD ANY DOCUMENTS.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: