Preliminary Information

Did anyone refer you to us?
YesNo

If yes, whom may we thank?

General Information

Client Full Legal Name

Preferred Name

Citizen of US
YesNo

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

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Date of Birth

Cell Phone

Place of Employment

Work Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Work Phone

Work Email

Best method of contact:

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

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?
YesNo

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

Other Preliminary Information

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

Personal Representative (1)

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Personal Representative (1)

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

Personal Representative (1)

Relation

Phone

Address

Street Address

Address Line 2

City

State

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

Zip/Postal Code

Country

2nd Guardian(s)

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

3rd Guardian(s)

Relation

Phone

Address

Street Address

Address Line 2

City

State

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

Zip/Postal Code

Country

1st Agent

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

1st Agent

Relation

Phone

Address

Street Address

Address Line 2

City

State

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

Zip/Postal Code

Country

2nd Surrogate

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

2nd Surrogate

Relation

Phone

Address

Street Address

Address Line 2

City

State

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).

2nd Surrogate

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

2nd Surrogate

Relation

Phone

Address

Street Address

Address Line 2

City

State

Zip/Postal Code

Country

3rd Surrogate

Relation

Phone

Address

Street Address

Address Line 2

City

State

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

Address

Work Address

Asset Information

Asset Information Continued

Other Preliminary Information

Address

Address

Address

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

Address

Address

Address

Durable Power of Attorney Designation?

Address

Address

Address

Health care Surrogate(s) Designation?

Address

Address

Address

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

Address

Address

Address

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