Estate Planning Intake Form Section 1: Client InformationSection 2: Family InformationSection 3: Personal Representatives, Guardians, Trustees and BeneficiariesSection 4: Miscellaneous Client InformationHusband’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 EmailHusband’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:PreviousNextChildrenPlease 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):PetsPlease 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:PreviousNextPersonal RepresentativesWho 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 GuardiansIf 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 TrusteesIf 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 PreviousNextMiscellaneousYour wishes concerning a Living Will and your burial can be noted in your Healthcare Power of Attorney formsAre 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 No Have One AlreadyDo you wish to be buried or cremated? Buried Cremated No PreferenceHave you made burial or cremation arrangements? Yes NoIf 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: Previous Submit Form
