Did anyone refer you to us?

Yes
No

If yes, whom may we thank?

Is this an amendment or revocation of a prior will or trust? If yes, what was the prior date of creation?

1st Spouse's Information

Full Name*

Preferred Name

Citizen of US?*

Yes
No

If not a citizen of the US, what country are you a citizen of?

Date of birth*

MM

DD

YYYY

Cell Phone*

Email*

Do you have life insurance?*

Yes
No

Do you receive medicaid, social security, or medicare payments?*

Yes
No

2nd Spouse's Information

Wife's Full Name*

Preferred Name

Citizen of US?*

Yes
No

If not a citizen of the US, what country are you a citizen of?

Date of birth*

MM

DD

YYYY

2nd Spouse's Cell Phone*

2nd Spouse's Email*

Do you have life insurance?*

Yes
No

Do you receive medicaid, social security, or medicare payments?*

Yes
No

Marital Information

Do you own or rent your home?*

Own
Rent

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County of Residence*

Home Phone

Children Information

Would you like to include future children in your estate plan?*

Yes
No

Is this your first marriage? (If not, indicate who is the parent of each child listed below)*

Yes
No

Child 1: Name, Age, Gender, Grandchildren

Child 2: Name, Age, Gender, Grandchildren

Child 3: Name, Age, Gender, Grandchildren

Child 4: Name, Age, Gender, Grandchildren

Child 5: Name, Age, Gender, Grandchildren

Child 6: Name, Age, Gender, Grandchildren

Are any of the children or grandchildren special needs?*

Yes
No

Do you have a specific breakdown of how you would want your children to receive their inheritances? Milestones? Different Ages? Lump Sum? (We will go over this in more detail with you so don't worry if you dont)

Asset Information

Checking Account Info. - Carrier, Name of Account Holder(s)

Savings Account Info. - Carrier, Name of Account Holder(s)

CD's

Brokerage (Number of accounts + identifying info)

Do you have life insurance?*

Yes
No

Asset Information Continued

Businesses Owned (legal title + owner)

Vehicles (description + title holder)

Other Important Assets

Specific Bequests & Gifts (Please list asset and to who you want it to go to)

Other Preliminary Information

Describe topics you want to discuss and how you want your estate to be distributed.

Do either spouse have specific burial or cremation requests? If so, what are they?

Personal Representative (Aka Trustee or Executor) of the estate (Usually name spouse first)

Would you like to name both spouses as each others first Personal Representative? (If you select yes for this, please provide two back ups in the Personal Representative (1) & (2) section below)

Yes
No

Personal Representative (1)*

Relation*

Personal Representative Address (1)*

Street Address Address Line 2 City State ZIP Code

Personal Representative (2)*

Relation*

Personal Representative Address (2)*

Street Address Address Line 2 City State ZIP Code

Personal Representative (3)

Relation

Personal Representative Address (3)

Street Address Address Line 2 City State ZIP Code

Personal Representative (4)

Relation

Personal Representative Address (4)

Street Address Address Line 2 City State ZIP Code

Children's Guardian Information (For children under age 18. Two persons may serve together as long as they are married)

1st Guardian(s)

Relation

2nd Guardian(s)

Relation

3rd Guardian(s)

Relation

Name of Spouse #1's durable power of attorney

A durable power of attorney gives the person(s) named the power to sign your name if you are not able to do so. For instance, it can be used to sign a deed or tax return, or to make gifts of your property. (Couples usually name their spouse first)

Would you like to name your spouse as your first Durable Power of Attorney? (If you select yes for this, please provide at least two back ups below)*

Yes
No

Spouse #1's 1st Agent

Relation

Spouse #1 1st Agent's Address

Street Address Address Line 2 City State ZIP Code

Spouse #1's 2nd Agent

Relation

Spouse #1 2nd Agent's Address

Street Address Address Line 2 City State ZIP Code

Spouse #1's 3rd Agent

Relation

Spouse #1 3rd Agent's Address

Street Address Address Line 2 City State ZIP Code

Name of Spouse #2's durable power of attorney?

A durable power of attorney gives the person(s) named the power to sign your name if you are not able to do so. For instance, it can be used to sign a deed or tax return, or to make gifts of your property. (Couples usually name their spouse first)

Would you like to name your spouse as your first Durable Power of Attorney? (If you select yes for this, please provide at least two back ups below)*

Yes
No

Spouse #2's 1st Agent

Relation

Spouse #2 1st Agent's Address

Street Address Address Line 2 City State ZIP Code

Spouse #2's 2nd Agent

Relation

Spouse #1 2nd Agent's Address

Street Address Address Line 2 City State ZIP Code

Spouse #3's 3rd Agent

Relation

Spouse #2 3rd Agent's Address

Street Address Address Line 2 City State ZIP Code

Name of Spouse #1's health care surrogate(s)?

A health care surrogate is allowed to make health care decisions on behalf of the person incapacitated. (Couples usually name their spouse first)

Would you like to name your spouse as your first Health Care Surrogate? (If you select yes for this, please provide at least two back ups below)*

Yes
No

Spouse #1's 1st Surrogate

Relation

Phone

Spouse #1's 1st Surrogate Address

Street Address Address Line 2 City State ZIP Code

Spouse #1's 2nd Surrogate

Relation

Phone

Spouse #1's 2nd Surrogate Address

Street Address Address Line 2 City State ZIP Code

Spouse #1's 3rd Surrogate

Relation

Phone

Spouse #1's 3rd Surrogate Address

Street Address Address Line 2 City State ZIP Code

Name of Spouse #2's health care surrogate(s)?

A health care surrogate is allowed to make health care decisions on behalf of the person incapacitated. (Couples usually name their spouse first)

Would you like to name your spouse as your first Health Care Surrogate? (If you select yes for this, please provide at least two back ups below)*

Yes
No

Spouse #2's 1st Surrogate

Relation

Phone

Spouse #2's 1st Surrogate Address

Street Address Address Line 2 City State ZIP Code

Spouse #2's 2nd Surrogate

Relation

Phone

Spouse #2's 2nd Surrogate Address

Street Address Address Line 2 City State ZIP Code

Spouse #2's 3rd Surrogate

Relation

Phone

Spouse #2's 3rd Surrogate Address

Street Address Address Line 2 City State ZIP Code

Estate Planning

Asset Protection

Business Law

Probate

Elder Law

Guardianship Law

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Practice Areas

Preliminary Information for a Couple

1st Spouse's Information

2nd Spouse's Information

Marital Information

Children Information

Asset Information

Asset Information Continued

Other Preliminary Information

Personal Representative (Aka Trustee or Executor) of the estate (Usually name spouse first)

Children's Guardian Information (For children under age 18. Two persons may serve together as long as they are married)

Name of Spouse #1's durable power of attorney

Name of Spouse #2's durable power of attorney?

Name of Spouse #1's health care surrogate(s)?

Name of Spouse #2's health care surrogate(s)?

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