Client Information Client Info Full legal name * Phone Number * Date of Birth Email * Address Marital Status MarriedUnmarried Last 3 Digits of Social Security Number Referral Source Are you (and your spouse, if married), US Citizens? YesNo Name of current spouse/partner For any previous marriages, please list the name of the spouse, whether the marriage ended due to death or divorce, and the date of divorce or spouse's death List all of your children's names and indicate whether they are adults or minors (if minors, please also note age). If any child is deceased please note that as well. Are all of your children of your current marriage? Yes No If you wish to distribute any of your estate to siblings, grandchildren, nieces or nephews, or other relatives or friends, please list their names, addresses, phone numbers and indicate if any is a minor. Please check all of the statements below which apply to you: * I have never executed a Will before or I have executed a will before Are you a beneficiary, trustee (singly or jointly) or creator of a trust? Yes No Describe in general terms how you wish to distribute your property. It need not be detailed at this point, but will provide a useful starting point. If your spouse is a beneficiary, do you want the Outright In Trust Property to be distributed outright or in trust for his/her benefit? Yes No If your children are beneficiaries, do you want the property to be distributed to them outright or in trust? Outright In Trust Please list the names of your possible executors, guardians, guardians for minors, financial powers of attorney, and health care powers of attorney in the order in wish you want them to serve. Please list one primary and two alternates for each. Please also list their names, addresses, phone numbers, email addresses, and relationship to you. Do you own any mineral interests on your primary residence or any other property? Yes No Please list the value and location of all assets: 1. Checking, savings, money market accounts, CDs, and similar liquid accounts * 2. Brokerage/mutual fund accounts 3. IRAs & other retirement accounts 4. Individual stocks, bonds, or other securities 5. Closely held business interests 6. Business personal and intellectual property (e.g. patents) 7. Vehicles, boats, airplanes, and other titled transportation items 8. Personal property (household items, jewelry, etc.) 9. Airline miles, reward points from loyalty programs 10. Items in safe deposit boxes Do you have any reproductive genetic material stored at an IVF or similar facility? Yes No Do you own any firearms or other weapons regulated by the National Firearms Act, or other Yes No firearms which you may wish to make special provision for? With respect to the distribution of your property, do you prefer to Make the process as easy and inexpensive as possible for my executor, even though this may mean less Court supervision Make the process dependent on Court permission With respect to your Durable (Financial) Power of Attorney, please name your agents, in order of succession (name, address, phone number, email) With respect to your Medical Power of Attorney, please name your agents, in order of succession (name, address, phone number, email) Do you have any reason to believe your Will is likely to be contested? Yes No Are you, or might you possibly be, prohibited from making a new will or limited in your ability to devise your property due to any of the following: Yes No Have your designees consented to serve, or, if you have not yet asked, do you believe they will be willing and able to serve? Yes No reCAPTCHA Submit
