Client Intake Form

Contact Information

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Phone Number

Form: Last Will and Testament (Outright to spouse and children)

Husband Name

Wife Name

Address

NUMBER of CHILDREN or DEPENDENTS to inherit

FULL LEGAL NAME of Child(ren) or Dependents

If applicable, in the event of death or incapacity of BOTH parents, who do you wish to appoint as Guardian for Minor Children/Dependents? Please state the full legal name and address. *Remaining characters: 500

If applicable, in the event of death or incapacity of BOTH parents, who do you wish to appoint as trustee for finances of children’s inheritance. This may be same or different as Guardian. Please state the full legal name and address. *Remaining characters: 500

FULL LEGAL NAME of the Personal Representative of Husband’s Will (usually spouse)

FULL LEGAL NAME of the back-up Personal Representative of Husband’s Will

FULL LEGAL NAME of the back-up Personal Representative of Wife’s Will

For Power of Attorney

Who do you wish to designate as Husband’s Agent (usually spouse)? Full Name and Address *Remaining characters: 500

Who do you wish to designate as Husband’s back-up Agent (optional)? Full Name and Address *Remaining characters: 500

Who do you wish to designate as Wife’s Agent (usually spouse)? Full Name and Address *Remaining characters: 500

Who do you wish to designate as Wife’s back-up Agent (optional)? Full Name and Address *Remaining characters: 500

For Health Care Surrogate

Who do you wish to designate as Husband’s surrogate? Full Name, Address and Phone number *Remaining characters: 500

Who do you wish to designate as Husband’s back-up surrogate? Full Name, Address and Phone number *Remaining characters: 500

Who do you wish to designate as Wife’s surrogate? Full Name, Address and Phone number *Remaining characters: 500

Who do you wish to designate as Wife’s back-up surrogate? Full Name, Address and Phone number *Remaining characters: 500

FOR TRUSTS

Each spouse will be co-trustees. Please state the name and address of back-up trustee *Remaining characters: 500

List any real estate or financial accounts that will be immediately transferred into the trust *Remaining characters: 500

Disbursement to beneficiaries (in the event both spouses are deceased): Default is age 18. If you have any specific requests (age, graduation of college, marriage, etc.) please list disbursement instructions here. There must be a final distriubtion. *Remaining characters: 500

Please add 4 and 3:

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