Estate Planning Intake Form

Client Information

Husband’s Full Legal Name:

Wife’s Full Legal Name:

Address:

City, State, Zip:

Home Phone:

Husband’s Cell Phone:

Husband’s Office Phone:

Wife’s Cell Phone:

Wife’s Office Phone:

Husband’s Email:

Wife’s Email

Husband’s Date and Place of Birth:

Wife’s Date and Place of Birth:

Date and Place of Marriage:

Husband’s Employer Name, Address, and Telephone:

Wife’s Employer Name, Address, and Telephone:

Children

Please use full legal names when entering children

To add a new text box for additional children, click the plus sign on the right.

Name	Age	Phone	Address

Name(s) of Children with Special Needs (if any):

Pets

Please list any pets you own and how you want them to be taken care of when you pass

Please click the + sign on the right to add any additional pets

Pet Name(s)	Pet Species	How should this pet be taken care of?

Names of other family members (if living):

Husband’s Parents:

Husband’s Brothers and Sisters:

Wife’s Parents:

Wife’s Brothers and Sisters:

Personal Representatives

Who do you desire to be the Personal Representative (Executor) of your probate estate?

First Choice for Personal Representative (after your spouse):

Name	Address	Telephone	Relationship

Second Choice for Personal Representative:

Name	Address	Telephone	Relationship

Third Choice for Personal Representative:

Name	Address	Telephone	Relationship

Guardians

If your children are still minors or are handicapped, whom would you desire to be their Guardians if both parents pass away before they become adults?

First Choice for Guardian:

Name	Address	Telephone	Relationship

Second Choice for Guardian:

Name	Address	Telephone	Relationship

Third Choice for Guardian:

Name	Address	Telephone	Relationship

Trustees

If you have minor children, or if you wish to have your estate held until your children are older before they receive their inheritance, whom do you desire to be the Successor Trustees of your estate?

First Choice for Successor Trustee:

Name	Address	Telephone	Relationship

Second Choice for Successor Trustee:

Name	Address	Telephone	Relationship

Third Choice for Successor Trustee:

Name	Address	Telephone	Relationship

Beneficiaries

First Choice for Beneficiaries and Percentages:

Name	Address	Telephone	Relationship

Second Choice for Beneficiaries and Percentages:

Name	Address	Telephone	Relationship

Third Choice for Beneficiaries and Percentages:

Name	Address	Telephone	Relationship

Miscellaneous

Your wishes concerning a Living Will and your burial can be noted in your Healthcare Power of Attorney forms

Are you or your spouse organ donors? If so, please specify below:

Do you wish to have a Living Will (instructing your family and physicians regarding the medical care and other treatment that you wish to receive in the event you are in a coma)?

Yes

Have One Already

Do you wish to be buried or cremated?

Buried

Cremated

No Preference

Have you made burial or cremation arrangements?

Yes

If so, with whom?

How did you hear about this office’s practice in the area of Will’s and Trusts?

Please list any other questions or special circumstances that you wish to discuss: