Client #1
Full Name:_____________________________________________________
Home Address:_________________________________________________
__________________________________________________________________
Home Phone: _____________________Cell Phone:_________________
Work Phone:_____________________Work Email__________________
Client #2
Full Name: ________________________________________________________
Home Address: _________________________________________________
___________________________________________________________________
Home Phone: ___________________________Cell Phone:_______________
Email:_______________________________________________________________
Work Phone:___________________________Work Email:_______________
Referred by: _____________________________________________________
What estate planning documents are currently in place? Please provide copies
__________________________________________________________________________________
FAMILY
*Please indicate if any children are not from the current marriage.
___________________________________________________________________________
Child or Dependent’s full name:_______________________________
Address__________________________________________________________
Birthdate:________________________________________________________
Spouse:___________________________________________________________
*repeat as necessary for each child/dependent
_________________________________________________________________________
Grandchild’s full name________________________________________________
Address__________________________________________________________________
Birthdate:________________________________________________________________
Parent:___________________________________________________________________
*repeat as necessary for each grandchild
Trustee/Executor
Who do you want to act as Trustee or Executor to manage and distribute your estate?
Client 1 1st______________________________ Client 2 1st____________________________________
2nd________________________ 2nd_____________________________________
3rd_________________________ 3rd_____________________________________
Durable Power of Attorney for property
If you become unable to make financial decisions, who should make them on your behalf?
Client 1 1st__________________________ Client 2 1st_____________________________
2nd_________________________ 2nd_____________________________
3rd__________________________ 3rd______________________________
Durable Power of Attorney for Health Care
If you become unable to make health care decisions, who should make them on your behalf?
Client 1 1st_______________________________ Client 2 1st_______________________________
2nd_____________________________ 2nd_______________________________
3rd_______________________________ 3rd_______________________________
Guardian of Minor Children
Pleased provide name (s) and address(es)
1st___________________________________________
2nd___________________________________________
At what age(s) should the children receive their share of the estate? ______________
What restrictions, if any, should be placed on the funds?_______________________________
Who should manage your children’s inheritance until they reach the specific age?
_____________________________________________________________________________________________