Preliminary Information for a Couple

Did anyone refer you to us?
YesNo

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
YesNo

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

Date of birth

Cell Phone

Do you have life insurance?
YesNo

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

2nd Spouse's Information

Wife's Name

Preferred Name

Citizen of US
YesNo

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

Date of birth

2nd Spouse's Cell Phone

2nd Spouse's Email

Do you have life insurance?
YesNo

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

Marital Information

Do you own or rent your home?
YesNo

Home Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

County of Residence

Children Information

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

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

Child 1: Legal Name, Age, Gender, Grandchildren

Child 2: Legal Name, Age, Gender, Grandchildren

Child 3: Legal Name, Age, Gender, Grandchildren

Child 4: Legal Name, Age, Gender, Grandchildren

Child 5: Legal Name, Age, Gender, Grandchildren

Child 6: Legal Name, Age, Gender, Grandchildren

Do you have any children or grandchildren with special needs?
YesNo

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?
YesNo

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)
YesNo

Personal Representative (1)

Relation

Personal Representative Address (1)

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Personal Representative (2)

Relation

Personal Representative Address (2)

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Personal Representative (3)

Relation

Personal Representative Address (3)

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Personal Representative (4)

Relation

Personal Representative Address (4)

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

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

2nd 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)
YesNo

Spouse #1's 1st Agent

Relation

Spouse #1 1st Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #1's 2nd Agent

Relation

Spouse #1 2nd Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #1's 2nd Agent

Relation

Spouse #1 3rd Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Name of Spouse #2's durable power of attorney

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)
YesNo

Spouse #2's 1st Agent

Relation

Spouse #2 1st Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #2's 2nd Agent

Relation

Spouse #2 2nd Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #2's 2nd Agent

Relation

Spouse #2 3rd Agent's Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

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)
YesNo

Spouse #1's 1st Surrogate

Relation

Phone

Spouse #1's 1st Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #1's 2nd Surrogate

Relation

Phone

Spouse #1's 2nd Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #1's 3rd Surrogate

Relation

Phone

Spouse #1's 3rd Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

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)
YesNo

Spouse #2's 1st Surrogate

Relation

Phone

Spouse #2's 1st Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #2's 2nd Surrogate

Relation

Phone

Spouse #2's 2nd Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Spouse #2's 3rd Surrogate

Relation

Phone

Spouse #2's 3rd Surrogate Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Estate Planning

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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

Home Address

Children Information

Asset Information

Asset Information Continued

Other Preliminary Information

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

Personal Representative Address (1)

Personal Representative Address (2)

Personal Representative Address (3)

Personal Representative Address (4)

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

Spouse #1 1st Agent's Address

Spouse #1 2nd Agent's Address

Spouse #1 3rd Agent's Address

Name of Spouse #2's durable power of attorney

Spouse #2 1st Agent's Address

Spouse #2 2nd Agent's Address

Spouse #2 3rd Agent's Address

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

Spouse #1's 1st Surrogate Address

Spouse #1's 2nd Surrogate Address

Spouse #1's 3rd Surrogate Address

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

Spouse #2's 1st Surrogate Address

Spouse #2's 2nd Surrogate Address

Spouse #2's 3rd Surrogate Address