Estate Planning Client Intake Form
Please complete this Estate Planning Client Intake Form to the best of your knowledge. Please provide as much detail as possible so that I can accurately evaluate your situation and properly advise you regarding your estate planning options. If you are unsure about how to answer some of the questions, simply indicate on the form that you would like to discuss the subject matter at our initial consultation.
Please use full legal names
Client 1
First Name
Middle Name
Last Name
Client 1 Birthdate
-
Month
-
Day
Year
Date
Client 1 Last 4 digits of Social Security Number
Client 1 Military Service
Yes
No
Client 1 - Phone Number
Format: (000) 000-0000.
Client 1 - E-mail
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Client 2
First Name
Middle Name
Last Name
Client 2 Birth Date
-
Month
-
Day
Year
Date
Client 2 Last 4 digits of Social Security Number
Client 2 Military Service
Yes
No
Client 2 - Phone Number
Format: (000) 000-0000.
Client 2 - E-mail
example@example.com
Address - If different from above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clients Married?
Yes
No
Date of Marriage
-
Month
-
Day
Year
Date
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Children and Dependents Information
Child 1 Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child of Whom?
Please Select
Both Clients
Client 1
Client 2
Child 2 Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child of Whom?
Please Select
Both Clients
Client 1
Client 2
Child 3 Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child of Whom?
Please Select
Both Clients
Client 1
Client 2
Child 4 Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child of Whom?
Please Select
Both Clients
Client 1
Client 2
Additional children or dependents
MINOR CHILDREN - Who would act as Guardian?
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Do any of the following situations apply to you or your family?
Are you currently receiving Social Security, disability or other government benefits?
Do you have a pre/post marriage agreement?
Do you currently have an estate plan?
Do you own property in Montana?
Do you own property in any state OTHER than Montana?
Are any of your children disabled?
Do you have pets or livestock that need to be planned for?
Would you like to Discuss any of these common issues during your consultation?
Avoiding probate
Planning for your incapacity or a disability
Maintaining control over your assets while you are alive
Ensuring that your end of life wishes are respected
Addressing a conflict with a family member that could affect your estate plan
Protecting your assets from lawsuits or other creditors
Ensuring that your estate plan stays intact in the event you die and your spouse remarries
Providing for your favorite charity after you die
Transferring your business interest(s) before or after you die
Planning for any concerns you may have about your children’s lifestyle, marriage, etc.
Using physician-assisted suicide if you are terminally ill
Disposition of remains?
Cremated
Buried
Do you currently have preplanned funeral arrangements or plots?
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Personal Representative / Successor Trustee
This person will administer your estate after you pass away.
Client 1
Who would you like to act as your PERSONAL REPRESENTATIVE OR TRUSTEE?
Personal Representative
Client 2
Who would you like to act as your PERSONAL REPRESENTATIVE or TRUSTEE?
Personal Representative
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Financial Power of Attorney
A financial power of attorney (POA) is a legal document that grants a trusted agent the authority to act on your in financial matters, if you are unable to.
Client 1
Who would you like to act as your FINANCIAL POWER OF ATTORNEY?
Client 2
Who would you like to act as your FINANCIAL POWER OF ATTORNEY?
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Healthcare Power of Attorney
A healthcare power of attorney (POA) is a legal document that grants a trusted agent the authority to make medical decisions on your behalf if you are unable to.
Client 1
Who would you like to act as your HEALTHCARE POWER OF ATTORNEY?
Client 2
Who would you like to act as your HEALTHCARE POWER OF ATTORNEY?
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Assets
The number and type of assets you own make a difference in what type of planning you may need. This information is used to ensure Shyne Law Group, PLLC has the full picture of your estate.
Do you own any of the following?
Bank Accounts/CD/Money Market Accounts
Primary Real Estate - Home
Real Estate - Other than your home
Personal effects - antiques/jewelry/cars
Investments
IRA/401K
529 plans
Life Insurance
Annuities
Mortgage
Oil/Gas/Mineral Interests
Business Interests
Large anticipated inheritance or gifts
Real Property
Address
Primary Residence - Yes or No
Name(s) on Deed
Value
Postal / Zip Code
Real Property
Address
Primary Residence - Yes or No
Name(s) on Deed
Value
Postal / Zip Code
Real Property
Address
Primary Residence - Yes or No
Name(s) on Deed
Value
Postal / Zip Code
Real Property
Address
Primary Residence - Yes or No
Name(s) on Deed
Value
Postal / Zip Code
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Assets
Account Information
Business Interests - LLC, Corp, Partnership, Solo
Life Insurance
Valuable Personal Property
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Submit
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