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Meet Scott
Contact Us
Schedule Online
Forms
☎ (440) 279-4112
Estate Planning Intake Form for Single Person
Estate Planning Intake Form for Single Person
Single Person Preliminary Information
Full Legal Name:
*
First Name
Last Name
I prefer to be called:
Date of Birth
*
MM
DD
YYYY
Occupation
*
Home Phone
(###)
###
####
Cell Phone
(###)
###
####
Email Address
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
County of Residence
*
Are you a U.S. Citizen?
Select
Yes
No
Children
Please List Your Child(ren)
Full Name, Gender, Date of Birth, # of Grandchildren
Is it possible for you to have or adopt more children?
Select
Yes
No
Do any of the children have mental or health related impairments/disabilities?
Select
Yes
No
If so, please describe:
Are you concerned with any of your children wasting their inheritance?
Select
Yes
No
Are you concerned about the spouse of your children receiving any of their inheritance?
Select
Yes
No
What topics would you like to discuss at your appointment?
Asset Information (Approximate Value)
Life Insurance:
IRA's, 401(k)'s, Profit Sharing, etc.:
Residence:
Other Real Estate:
Stocks, Bonds, Mutual Funds:
Cash, CD's, Savings, Checking:
Money Owed to You:
Business Interests:
Cars, Jewelry, Furniture, etc.:
Expected Inheritance:
Approximate Total Estate Value:
$
Disposition of Property
Will someone other than your child(ren) receive a portion of your estate?
Select
Yes
No
If yes, please list below:
Upon your death, briefly describe how you would like your estate to pass:
Whom do you want to name as the Personal Representative/Executor/Trustee of your estate?
Initial Choice:
Personal Representative/Executor/Trustee
Back Up #1:
Personal Representative/Executor/Trustee
Back Up #2:
Personal Representative/Executor/Trustee
Whom do you want to name as guardian(s) of your child(ren), if applicable?
Initial Choice:
Guardian of Child(ren)
Back Up #1:
Guardian of Child(ren)
Back Up #2:
Guardian of Child(ren)
Whom do you want to name as agent on your durable power of attorney?
(Spouses typically name each other first. This power of attorney gives the person(s) you name the power to sign your name if you are not able to do so).
Initial Choice:
Durable POA
Back Up #1:
Durable POA
Back Up #2:
Durable POA
Do you want to give your agent superpowers on your Durable Power of Attorney to gift assets or change beneficiaries in order to plan for Disability or Medicaid?
(This gives your agent broad discretion to give away your assets or change beneficiaries).
Select
Yes
No
Whom do you want to name as agent on your Health Care Power of Attorney / Health Care Surrogate?
(Spouses normally name each other first. This document allows you to appoint someone to make medical decisions on your behalf should you become incapacitated).
Initial Choice:
Health Care Power of Attorney / Surrogate
Back Up #1:
Health Care Power of Attorney / Surrogate
Back Up #2:
Health Care Power of Attorney / Surrogate
Thank you!
