Franklin & Frankel Estate Planning Intake Form

ESTATE PLANNING INTAKE FORM
All information will be kept CONFIDENTIAL, unless you authorize or request its release to others.

The purpose of this questionnaire is to: 1) help you organize personal and financial information so that you can assess your current estate plans and evaluate whether changes are necessary; and (2) provide us with the information needed to make a similar analysis.

State ALL names requested below exactly as you want them to appear in your estate planning documents.

Note: Not all of the questions will apply to your circumstances.

Please fill out the form to the best of your ability. Anything you need to leave blank, you may, but the more complete and detailed you make your form, the more informed we will be in our initial meeting.

Tel. (860) 561-4832 | Fax: (860) 521-5560 | Email: info@franklawllc.com
WILL & TRUST BACKGROUND INFORMATION
Do you have an existing will?
Do you have an existing trust?
Personal Information
Your Name (as you write it in your signature)
Date of Birth

MonthDayYear
Date
Email
example@example.com
Cellphone Number
Home Number
Work Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a United States citizen?

YesNo
Spouse/Partner Personal Information
Spouse/Partner's Legal Name
Spouse/Partner's Date of Birth

MonthDayYear
Date
Date of Marriage (if married)

MonthDayYear
Date
Spouse/Partner's Email (if applicable)
example@example.com
Spouse/Partner's Cellphone Number
Is your spouse/partner a United States citizen?

YesNo
Prior Marriages
Do you have any prior marriages?

YesNoOther
Please list full Name(s), Date(s) of Marriage(s), and Date(s) of Divorce(s) for any Prior Marriage(s):

FAMILY INFORMATION
Please LIST name and age of ALL of your children. If a child is from a former marriage, please indicate whose child it is by listing the name of that spouse, along with the information of WHOSE child in the space below. Please name all children you have ever had, including deceased children (whether or not their descendants will be included in your plan). Please note if the child is adopted or a step-child.

If you do not have any children, please list:

1. Names of Parents (living or deceased)
2. Names of any siblings (living or deceased)
3. Name of each relative or friend you would wish to include in your estate distribution

Please include Town and State of Residence for each living legal adult listed below.
Do any of the people identified above have any special mental, physical or educational needs? If SO please identify them and briefly describe any concerns:

WILL EXECUTORS, TRUSTEES, AND GUARDIANS
Executor

Your executor has the responsibility to handle your affairs at the time of your death. Who would you like to designate as your Executor(s) upon your death and the death of your spouse?
Executor Name
Relationship to You (the person making the will)
Executor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Successor Executor Name(s)
To act if the initial executor(s) cannot or do not choose to serve
Relationship(s) to You (the person making the will)
Successor Executor(s) Address(es)
Trustees

If you choose to form a trust, your trustees are responsible for the management of the trust, and distribution of the trust funds. (Note: Generally the trustee and the guardian of your children should not be the same.)
Initial Trustee(s) or Co-Trustee(s) Name(s)
Relationship(s) to You (the person making the trust)
Address(es)
Successor Trustee(s) Name(s)
To act if one or more of the initial trustees cannot or does not act
Relationship(s) to You (the person making the trust)
Addresse(s)
Guardian

If you have minor children, you may designate a guardian (or guardians) of the person and their estate if you and your spouse were to die or become incapacitated.
Do you have any minor children?

YesNo
Guardian Name
Relationship to You (the person making the will)
Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Successor Guardian Name
Relationship to You (the person making the will)
Successor Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PERSONAL AND FAMILY FINANCIAL ASSETS
Your current place of employment
Spouse/Partner's current place of employment (if applicable)
Address of Owned Real Estate

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mortgage Balance
Current Market Value
Describe any additional real estate (include address, mortgage balance, current market value)
Approximate value of your total assets
Approximate value of your spouse/partner's total assets (if applicable)
Approximate value of your joint total assets
Amount of life insurance (you)
Amount of life insurance (spouse/partner)
Describe any trusts created by you or inherited in which you or a member of your immediate family has a right to receive distributions of income or principal. Also state the approximate current value of the trust and the annual income from it.

PERSONAL ESTATE PLANNING OBJECTIVES
Please list any specific gifts of personal property or money you would like to make:
How would you like the remainder of your personal property distributed?
How would you like the remainder of your assets distributed?
If you have children, do you want them to receive their share of your estate outright or in trust?
If a child is a beneficiary, how should their share be distributed if they fail to survive you? To their children, back to other children/descendants, or elsewhere?
If you decide to leave your assets to your children in your trust, at what age or ages would you want them to receive the principal?
In the event of an unforeseen situation that was to claim the lives of your entire immediate family, where would you want your assets to go?
Do you intend on disinheriting anyone? If so please provide their names and your relation to them.
Is there anyone likely to contest your estate documents? If so please provide their names and your relation to them.

POWER OF ATTORNEY & LIVING WILL/ HEALTHCARE INSTRUCTIONS
Powers of Attorney - would you like us to prepare a general durable Power of Attorney? This document would allow someone to handle financial matters on your behalf

YesNoOther
If yes please provide the following information for the person you'd like to appoint - along with a successor, if desired: name, address, and relationship to you.
Healthcare Instructions - Would you like us to prepare a document indicating your wishes concerning extraordinary measures to be taken to save your life in the event of catastrophic illness or injury? This would authorize that person to make decisions with respect to your healthcare in the event you are unable to do so, and designate a conservator in the event one is needed.

YesNoOther
If yes please provide the following information for the person you'd like to appoint - along with a successor, if desired: name, address, and relationship to you.
Final Arrangements: Do you wish to be cremated, buried, or have other specific instructions for your remains? If you have particular wishes (e.g., scattering ashes, burial arrangements, specific location), please describe them below.
Whom would you like to select in order to make arrangements? Please provide their name, address, and relationship to you.
If you have any specific wishes for your pets, please list them here:
Are there any other estate planning matters you would like us to address for you?
Should be Empty:

ESTATE PLANNING INTAKE FORM

WILL & TRUST BACKGROUND INFORMATION

Personal Information

Spouse/Partner Personal Information

Prior Marriages

FAMILY INFORMATION

WILL EXECUTORS, TRUSTEES, AND GUARDIANS

Executor

Trustees

Guardian

PERSONAL AND FAMILY FINANCIAL ASSETS

PERSONAL ESTATE PLANNING OBJECTIVES

POWER OF ATTORNEY & LIVING WILL/ HEALTHCARE INSTRUCTIONS