Did anyone refer you to us?

Yes
No

If yes, whom may we thank?

General Information

Full Legal Name*

Preferred Name

Citizen of US?*

Yes
No

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

Address

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

Date of birth*

MM

DD

YYYY

Cell Phone*

Email*

Place of Employment

Work Address

Street Address Address Line 2 City State ZIP Code

Work Phone

Work Email

Best method of contact:*

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

Yes
No

Child 1: Legal Name, Age, Gender

Child 2: Legal Name, Age, Gender

Child 3: Legal Name, Age, Gender

Child 4: Legal Name, Age, Gender

Child 5: Legal Name, Age, Gender

Child 6: Legal Name, Age, Gender (If you have more children than 6 please include that in a separate note)

Do you have grandchildren?

Yes
No

Do you have any children or grandchildren with 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

Other Preliminary Information

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

Personal Representative Designation

This person or entity will manage your legal affairs upon incapacitation or death.

Personal Representative (1)*

Relation*

Phone*

Address*

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

Personal Representative (2)*

Relation*

Phone*

Address*

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

Personal Representative (3)

Relation

Phone

Address

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

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

1st Guardian(s)

Relation

Phone

Address

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

2nd Guardian(s)

Relation

Phone

Address

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

3rd Guardian(s)

Relation

Phone

Address

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

Durable Power of Attorney Designation?

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.

1st Agent*

Relation*

Phone*

Address*

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

2nd Agent*

Relation*

Phone*

Address*

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

3rd Agent

Relation

Phone

Address

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

Health care Surrogate(s) Designation?

A health care surrogate is allowed to make health care decisions on behalf of the person incapacitated.

1st Surrogate*

Relation*

Phone*

Address*

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

2nd Surrogate*

Relation*

Phone*

Address*

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

3rd Surrogate

Relation

Phone

Address

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

Who do you want to name as trustee of your estate for your minor children (If applicable)?

This person or entity holds legal title to the property for a beneficiary (the beneficiaries).

1st Trustee

Relation

Phone

Address

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

2nd Trustee

Relation

Phone

Address

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

3rd Trustee

Relation

Phone

Address

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

Estate Planning

Asset Protection

Business Law

Probate

Elder Law

Guardianship Law

Download Your Free Estate Planning Guide

Practice Areas

Preliminary Information

General Information

Asset Information

Asset Information Continued

Other Preliminary Information

Personal Representative Designation

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

Durable Power of Attorney Designation?

Health care Surrogate(s) Designation?

Who do you want to name as trustee of your estate for your minor children (If applicable)?

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