Florida Conference Planned Giving and Trust Services Form

Florida Conference Planned Giving and Trust Services Form
Disclosure
Scripture and inspired writings encourage Christians to provide for themselves, their families and the Lord’s work through a properly prepared estate plan. With this in mind, the Florida Conference provides free consultation and financial assistance to church members who wish to prepare a Medical Advance Directives, Power of Attorney, Living Will, and Last Will and Testament. Our representatives are highly trained, however, representatives of Florida Conference Planned Giving and Trust Services Department (“PGTS”) are not attorneys and DO NOT provide legal, tax or financial advice.
Coordination with the Attorney
PGTS personnel will help you coordinate your plans with an attorney. Florida Conference will pay an attorney an agreed-upon fee for preparation of basic documents (including a “simple will”, [with designation of guardian for minor children, if applicable, but without any trust provisions], Durable Power of Attorney, Living Will, Designation of Health Care Surrogate and HIPAA Authorization). If, after consultation with the attorney, you decide to have additional documents, like a Revocable Living Trust, there may be additional costs and attorney’s fee for preparation of those documents which are not covered by Florida Conference.
Deposit Requested
A refundable deposit of $100 is required to start the process. This deposit is returned if you complete the process within one year.
Personal Representative
If you do not have someone to act as your trustee or personal representative, talk with your PGTS representative about the possibility of a designated employee of the Florida Conference Association serving as your personal representative or trustee.
Acknowledgment and Certification
I acknowledge that I have carefully read and fully understand the above Disclosure. I understand that representatives of the Florida Conference Planned Giving and Trust Services Department (“PGTS”) are not attorneys, do not provide legal or financial advice, and that any estate planning services will require coordination with an attorney.

By signing below, I/We certify that I/We have received and understood this Disclosure, that I have had the opportunity to ask questions, and that I agree to proceed under the terms described herein.
Member*

First NameLast Name
Member's Signature*

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Are you married?*

YesNo
Spouse

First NameLast Name
Spouse Signature

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Florida Conference Church Membership
Church where your membership is*

Personal Information
Church Member:
Title:
Full Name: First Name*   Last Name*
Date of Birth:   Date*
Address:   Street Address*      City*   State*   Zip*
County:   County*
Email:   Email*
Phone:      Phone Number
Employer Name: Employer Name*
Occupation:   Occupation*
Best time to call:   FromTime   to   Time
Spouse:
Title:
Full Name: First Name   Last Name
Date of Birth:   Date
Address:   Street Address      City   State   Zip
County:   County
Email:   Email
Phone:      Phone Number
Employer Name: Employer Name
Occupation:   Occupation
Best time to call:   FromTime   to   Time
Do you have a prenuptial or postnuptial agreement?*

YesNo
If you have a copy of your prenuptial or postnuptial agreement available, you may want to upload it now

Cancelof

Children
Do you have children?

YesNo
Please list your children*
Is any of your children under the age of 18?*

YesNo
Do any of your children have disabilities?*

YesNo
Guardians & Trustees for minors or children with disabilities
1. Guardian
Who would care for your children if you and your spouse are unable to do so?

Primary Guardian’s Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You
Phone Number:      Phone Number
Contingent Guardian’s Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You
Phone Number:      Phone Number
2. Testamentary Trustee
Who should manage assets for your children until they are old enough?

Primary Trustee's Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You*
Phone Number:      Phone Number*
Contingent Trustee's Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You*
Phone Number:      Phone Number*
3. Distribution Plan :
Detail the distribution plan, for example, half at 25 years of age, balance at 30 years

Section 5 – Estate Distribution
1. Married Couples
Since you are married, would you like to leave all your estate to your surviving spouse?*

YesNo
2. Specific Gifts
3. Distributions
Besides the specific gifts mentioned in section 5.2, please indicate how you want to distribute the remaining 100% of your assets.

Important: Please note that all the percentages in sections 5.3.1 and 5.3.2 combined must add up to 100%.
3.1 Distributions to Ministry - Store Up Treasures in Heaven
If you could impact the world for Christ through your legacy after your passing, what portion of your estate would you choose to leave in support of your local church or ministries—such as missions, church planting, evangelism, or youth programs?

If you would like to name your local church as a direct beneficiary of a bank account or life insurance policy, please name the Florida Conference Association of Seventh-day Adventists as the beneficiary and indicate in your will how you wish the funds to be distributed. Our EIN is 59-6137501
3.2 Distribution to family and friends
Per capita: If this beneficiary predeceases you, this share goes to the other beneficiaries named on this
form.
Per Stirpes: If the beneficiary predeceases you, this share of the estate is divided equally among the
beneficiary’s children.
4. Simultaneous Death
If all named beneficiaries predecease you, how should your estate be distributed?*

Nominations & Appointments
1 Durable Power of Attorney
Who should act on your behalf for legal and financial matters if you become incapacitated?

Primary Agent:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
Secondary Agent:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
How is the secondary agent designated in relation to the primary agent?

ContingentJoint
2 Health Care Surrogate
Who should make medical decisions if you cannot speak for yourself?

Primary Agent:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
Secondary Agent:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
How is the secondary agent designated in relation to the primary agent?

ContingentJoint
3 Personal Representative(s)
Who should gather your assets and manage your estate?

Primary Representative:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
Secondary Representative:   First Name*   Last Name*
Relationship to You:   Relationship to You*
Email:   Email*
Phone Number:      Phone Number*
How is the secondary representative designated in relation to the primary representative?

ContingentJoint
4. Revocable Trust
Would you like to have a Revocable Trust? (Revocable Trusts have additional fees)

YesNo
Primary Trustee's Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You*
Phone Number:      Phone Number*
Secondary Trustee's Name:   First Name*   Last Name*
Address:   Street Address*      City*   State*   Zip*
Relationship to You:   Relationship to You*
Phone Number:      Phone Number*

Financial Information

List your real estate, business interests, insurances, accounts, retirement assets, investments, debts & liabilities.
1. Real Estate
2. Personal Property (Eg: Mobile Home, Motorcycle, Car, Boat)
3. Bank Accounts
4. Retirement Accounts
5 Investment Accounts

Please select which law firm you choose to represent you and complete your estate planning documents:

Andrew G. MacKenzie [MACKENZIE LAW GROUP]Sandra Cornwall [CORNWALL LAW OFFICE PLLC]
MACKENZIE LAW GROUP

Attorneys at Law

288 Bells Ferry Road NE | Rome, Georgia 30161 | 706-442-3556

FULL DISCLOSURE STATEMENT

I understand that I qualify for estate planning services through the Florida Conference Association of Seventh[1]Day Adventists and I am requesting that these services be provided to me. I freely and voluntarily have chosen attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP to represent me, to prepare my estate planning documents, and to advise me concerning my estate plan. I understand that the fees for estate document preparation will be paid to attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP by Florida Conference Association of Seventh-Day Adventists as a service to its members. I agree to pay document preparation fees if I do not deliver properly completed estate planning documents to Florida Conference Association of Seventh-Day Adventists within 90 days after receipt of documents approved by me to be signed. I understand that I have the right and privilege to consult or obtain independent legal counsel at my own expense regarding any of these matters, and/or to review the document(s) prepared by attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP prior to signing such document(s).

If married, legal representation is for both spouses independently as well as jointly. I hereby consent to the dual representation for me and my spouse and to the disclosure of information received by me or my spouse, if applicable. Although information is shared, if there is any disagreement between me or my spouse about our respective estate plans, attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP will draft documents to carry out the wishes of each of us individually with respect to our separate plans. If either spouse believes for any reason that continued joint representation raises a conflict of interest, then either (or both) is free to withdraw from representation at any time and obtain separate counsel. The information that I supply will be the basis for my estate plan. I take responsibility for any and all impact on my estate plan if any information provided by me is not correct, realizing my plan can only be based on the information I provide. I understand that it is my responsibility to review the prepared documents to confirm that my wishes are accurately reflected. If my estate plan should include estate documents and/or additional legal work not covered by Florida Conference Association of Seventh-Day Adventists, I understand that it is my responsibility to 1) pay all fees for the preparation of such work, and 2) transfer all assets according to the instructions provided by attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP. I will hold Florida Conference Association of Seventh[1]Day Adventists and attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP harmless from any liability if such transfers are not timely completed or properly executed.

I understand that attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP may from time to time represent the Florida Conference Association of Seventh-Day Adventists I specifically waive any conflict of interest that such representation may entail.

I give attorney Andrew G. MacKenzie, MACKENZIE LAW GROUP and Florida Conference Association of Seventh-Day Adventists permission to keep a copy of the documents prepared for me.
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Witness Signature*

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Cornwall Law Office, PLLC
P.O. Box 120253, Clermont, FL 34712
Ph. (561) 573-1969 ● Fax (352) 227-3508
Email: CornwallLawoffice@gmail.com

Dear Church Member,

You qualify for estate planning services through the Florida Conference Association of Seventh-day Adventists. Thank you for selecting our firm to prepare your basic estate planning documents. Although the Florida Conference Association of Seventh-day Adventists will be paying my fee, I want to make it explicitly clear that you are my client—not the Conference, your church, or any other entity.

Because a third party is covering the cost of your estate planning, there is a possibility that someone could later claim a conflict of interest if your will were ever challenged. To avoid any such concern and to ensure full transparency, I have prepared this agreement for you to acknowledge these circumstances and waive any potential conflict.

Please contact me once you have completed the estate planning worksheet provided to you by the field representative. After my office receives your intake form, I will reach out to review your worksheet with you. My highest priority is to ensure that your wishes are accurately understood and properly reflected in your documents. The information you provide will form the basis of your estate plan, and you are fully responsible for the accuracy of that information and for any impact inaccuracies may have on your plan.

You are responsible for reviewing all prepared documents to confirm that they correctly reflect your intentions. I also recommend that you have the documents reviewed by an attorney of your choosing to ensure they fully align with your wishes and goals.

By signing below, you acknowledge and understand the statements above and agree to waive any potential conflict of interest. You also give attorney Sandra Cornwall, Cornwall Law Office, PLLC and the Florida Conference Association of Seventh-Day Adventists permission to keep a copy of the documents prepared for you.
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Cornwall Law Office, PLLC
P.O. Box 120253, Clermont, FL 34712
Ph. (561) 573-1969 ● Fax (352) 227-3508
Email: CornwallLawoffice@gmail.com

Notice Regarding Durable Powers of Attorney

A Durable Power of Attorney is a powerful legal instrument that grants another person—your “agent” or “attorney-in-fact”—the authority to act on your behalf in financial and legal matters. This authority can include managing bank accounts, paying bills, handling real estate transactions, and making other significant decisions that may affect your assets and long-term financial well-being.

A Durable Power of Attorney is considered “durable” because it remains effective even if you later become incapacitated. It is therefore essential that you understand the seriousness of this document before signing it. Your agent may act as soon as the document is signed and their actions can legally bind you. Although the law imposes fiduciary duties on agents, misuse of a power of attorney can still cause substantial harm if the agent is not trustworthy or does not act in your best interest.

For these reasons, you should exercise great caution when selecting an agent. Choose someone whose judgment, integrity, and reliability you trust completely. You should also take time to review the scope of authority being granted and ask any questions you may have before signing.

If at any point you feel uncertain, uncomfortable, or unclear about the powers involved, please let me know. My role is to ensure that you fully understand your rights, the implications of this document, and the protections available to you.

Your careful consideration now helps safeguard your financial security and ensures that your wishes are respected in the future.

By signing below, you acknowledge that you have read and understand the foregoing notice.
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FOREST LAKE LAW, P.A.

Attorneys & Conselors at Law

Attorneys:

Carlos A. Martin, Esq

Josue M. Merino, Esq.

Contact:

Ph: 407-796-2939

Fax: 407-930-9449

Orlando Office:

8236 Lee Vista Blvd. Suite. D Orlando, FL 32829

Apopka Office:

628 N. Bear Lake Road Apopka, FL 32703

Dear Church Member,

You have chosen our firm to prepare your basic estate planning package documents. The Florida Conference of Seventh-Day Adventists is paying my fee of $275.00 per individual or $325.00 per couple.

However, in light of this fact, I want to make clear that you are my client and not the conference, church, or any other entity. There is the potential that someone may attempt to assert that there was a conflict of interest if they attempted to challenge the validity of your will. In order to avoid this, and to provide as much disclosure as possible, I've prepared this agreement wherein you acknowledge the foregoing and waive any conflict. Additionally, I request that you contact me upon your completing the estate planning worksheet provided to you by the field representative. You can reach me at:

Carlos A. Martin, Esquire

628 N. Bear Lake Road, Suite 102
Apopka, Florida 32703
(407) 796-2939

Once my office has received your intake form, a member of my staff will contact you to review your worksheet. It is my upmost priority that I ensure that your wishes are followed and that documents are drafted in accordance therewith. Further, I recommend that you have all documents reviewed by an attorney of your choosing to ensure that they accurately reflect your wishes and goals.

By Signing below, you are stating that you waive any conflict of interest and acknowldge and understand the above statements.
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NOTICE REGARDING DURABLE POWER OF ATTORNEY

A Durable Power of Attorney is an important legal document. By signing the Durable Power of Attorney, you are authorizing another person to act for you, the Principal, without any court supervision or approval. Each person you appoint to serve as your agent should be someone you trust completely. Before you sign the Durable Power of Attorney, you should know these important facts.

The Durable Power of Attorney is a very powerful document designed to give the designation person or persons (your "agent") the ability to manage your financial affairs. For instance, your agent has the power to manage, dispose of, sell and convey your real and personal property, to open and close bank accounts, to sign your tax returns, and to use your property as security if your agent borrows money on your behalf. These are just a few of the powers you are giving to your agent. Your agent will have the right to receive reasonable payment for services provided under the Durable Power of Attorney.

The powers you give your agent will continue to exist for your entire lifetime, unless you state that the Durable Power of Attorney will last for a shorter period of time or unless you otherwise terminate the Durable Power of Attorney.

The powers you give your agent in the Durable Power of Attorney will be effective the moment you sign the form, and they will continue to exist even if you no longer have the capacity to manage your property.

You can amend or change the Durable Power of Attorney only by executing a new Durable Power of Attorney or by executing an amendment through the same formalities as an original. You have the right to revoke or terminate the Durable Power of Attorney at any time, so as long as you are competent.

You should read the Durable Power of Attorney carefully. When effective, the Durable Power of Attorney will give your agent the right to deal with property that you now have or might acquire in the future.

By signing below, you acknowledge that you have read the foregoing notice.
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Agreement for Timely Execution

Dear Church Member,

You have chosen our firm to prepare your basic estate planning package documents. The Florida Conference of Seventh-Day Adventists is paying my fee of $275.00 per individual or $325.00 per couple. It is our desire that, once the documents are prepared, you execute them promptly as the future is uncertain for everyone.

The documents have no legal weight and are not enforced until they are signed by you, in front of two witnesses and a notary. I will be contacting you once the documents are prepared and will send you drafts for your confirmation. You will have ten (10) days to make any changes. If we do not hear from you, we will assume that you approve the documents and will set a time for the signing ceremony. If you are located in the Central Florida area, I would encourage you to contact my office so that we can have the signing here. If you are not, your field representative will be contacting you to set an appropriate date and time for the signing ceremony.

By signing below, you are stating that you agree to sign the prepared documents in a timely manner.
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Next Steps

Please call one of our field associates:

Luis Reyes
Field Associate
407-644-5000 ext 2244 / 407-618-0253
luis.reyes@floridaconference.com

Adeli Galvis
Field Associate
407-644-5000 ext 2246 / 407-618-0242
adeli.galvis@floridaconference.com

A representative from the Development and Planned Giving Department will verify this information.
We will send you the attorney’s disclosure letter via email. Please sign it.
Please send a $100 refundable* deposit via Zelle or PayPal. *If you complete your estate plan within one year, the $100 will be refunded.

Depositing via Zelle:
Log in to your financial institution and initiate a Zelle “Send/Pay” transfer. If you are unsure of how to use Zelle, please scan the QR code and select your financial institution to proceed.

Remit your Zelle deposit to: treasury@floridaconference.com (Florida Conference of Seventh-day Adventists)

IMPORTANT: Please make sure to include the following information:
Department - Deposit Amount – Your Full Name.
Eg: Planned Giving - $100 Deposit - John Doe

Depositing via PayPal:
Please email Andrew.Elliott@floridaconference.com requesting a PayPal Invoice for your Planned Giving Deposit. Note: PayPal charges you an additional $3 non-refundable processing fee.

We will forward your information to our attorney, and his office will email your draft estate planning documents.
Once the documents are ready, we will reach out to you to schedule an appointment to sign your final documents.

For questions or assistance, please contact us:
planned.giving@floridaconference.com | 407-644-5000 ext. 2241 / 2246

Should be Empty:

Florida Conference Planned Giving and Trust Services Form

Disclosure

Coordination with the Attorney

Deposit Requested

Personal Representative

Acknowledgment and Certification

Florida Conference Church Membership

Personal Information

Children

Guardians & Trustees for minors or children with disabilities

1. Guardian

2. Testamentary Trustee

3. Distribution Plan :

Section 5 – Estate Distribution

1. Married Couples

2. Specific Gifts

3. Distributions

3.1 Distributions to Ministry - Store Up Treasures in Heaven

3.2 Distribution to family and friends

4. Simultaneous Death

Nominations & Appointments

1 Durable Power of Attorney

2 Health Care Surrogate

3 Personal Representative(s)

4. Revocable Trust

Financial Information

1. Real Estate

2. Personal Property (Eg: Mobile Home, Motorcycle, Car, Boat)

3. Bank Accounts

4. Retirement Accounts

5 Investment Accounts

Next Steps