ESTATE PLANNING & BUSINESS DEVELOPMENT INTAKE FORM
Please complete the following information as thoroughly as possible.
I. CLIENT INFORMATION
First Name
Middle Name
Last Name
U.S. Citizen ?
Privacy Policy
II.
Current Marital Information
Current Marital Status
Spouse Full Legal Name
Spouse's Date of Birth
Spouse's Citizenship
Spouse Citizenship
Date of Marriage
Prenuptial or Postnuptial Agreement?
YES
NO
Privacy Policy
III.
Additional Client Information
How would you like your name to read on your estate planning documents?
Other Names Known By
Date of Birth and Year
Place of Birth
Phone
*
Email
*
Privacy Policy
III.
Employment Information
Currently Employed?
Yes
No
If Yes, how long?
Occupation
Employer / Business Name
Address
Street Address
City
State
Postal Code
Business Title
Business Phone No.
Business Fax No.
Business Email Address
Privacy Policy
III.
Primary Residence
Primary Residence Street Address
Primary Residence City
Primary Residence County
Primary Residence State
Primary Residence Zip Code
Primary Residence Telephone No.
Primary Residence Fax No.
Primary Residence Seasonal Dates
Primary Residence Date Established
IV. Secondary Residence
Secondary Residence Street Address
Secondary Residence City
Secondary Residence County
Secondary Residence State
Secondary Residence Zip Code
Secondary Residence Telephone No.
Secondary Residence Seasonal Dates
Secondary Residence Date Established
Secondary Residence Fax No.
IV. Child 1
Father's Name
Mother's Name
Child 1 Name
Child 1 Current Address & Phone Number
Child 1 Other Parent Name
Child 1 Date of Birth
Child 1 Spouse Name
IV. Child 2
Child 2 Name
Child 2 Current Address & Phone Number
Child 2 Other Parent Name
Child 2 Date of Birth
Child 2 Spouse Name
IV. Child 3
Child 3 Name
Child 3 Current Address & Phone Number
Child 3 Other Parent Name
Child 3 Date of Birth
Child 3 Spouse Name
IV. Child 4
Child 4 Name
Child 4 Current Address & Phone Number
Child 4 Other Parent Name
Child 4 Date of Birth
Child 4 Spouse Name
IV. Child 5
Child 5 Name
Child 5 Current Address & Phone Number
Child 5 Other Parent Name
Child 5 Date of Birth
Child 5 Spouse Name
IV. Child 6
Child 6 Name
Child 6 Current Address & Phone Number
Child 6 Other Parent Name
Child 6 Date of Birth
Child 6 Spouse Name
IV. Grand Child 1
Grandchild Name
Grandchild Parent Number
Grandchild A Date of Birth
Grandchild Current Address
Grand Child 2
Grandchild Name
Grandchild Parent Number
Grandchild Current Address
Grandchild Date of Birth
Current Estate Plan
Please provide copies of any of the below documents.
Do you have a Will?
Yes
No
Have you created a Trust?
Yes
No
Do you have a Power of Attorney?
Yes
No
Do you have a Living Will / Advance Directive?
Yes
No
Estate Planning Documents Reviewed Within Past 3 Years?
Yes
No
Are you the Grantor, Trustee, or Beneficiary of any Trust?
Yes
No
Attorney / Firm Who Prepared Current Documents
Estate Documents Date Last Updated
Professional Advisors
Accountant Name
Accountant Firm Name
Accountant City
Accountant Telephone No
Accountant Email Address
Professional Advisors
Financial Advisor Name
Financial Advisor Firm Name
Financial Advisor City
Financial Advisor Telephone No.
Financial Advisor Email Address
Professional Advisors
Insurance Agent Name
Insurance Agent Firm Name
Insurance Agent City
Insurance Agent Telephone No.
Insurance Agent Email Address
Professional Advisors
Estate Planning Attorney Name
Estate Planning Attorney Firm Name
Estate Planning Attorney City
Estate Planning Attorney Telephone No.
Estate Planning Attorney Email Address
Retirement Planning & Accounts
Are you currently retired?
Yes
No
Your Desired/Actual Retirement Age
Spouse's Desired/Actual Retirement Age
What sources of retirement income do you anticipate relying on?
Social Security
Pension
401(k) / 403(b) / IR
Business Sale or Income
Rental / Investment Income
Annuity Income
Other
Have you developed a formal plan for how you will draw down your retirement assets?
Yes
No
Are you concerned about outliving your retirement assets?
Yes
No
Have you reviewed your Social Security claiming strategy?
Yes
No
Estimated Monthly Retirement Income Need
Estimated Current Monthly Income
Retirement Account Schedule
Business Ownership & Structure
Do you own an interest in a closely held business?
Yes
No
Buy-Sell Transfer / Valuation Provisions
Business Ownership Details
Is there a buy-sell agreement in place among the owners?
No
Are there restrictions on transferring ownership interests (e.g., right of first refusal, consent requirement)?
YES
NO
May this business interest be transferred into a trust?
YES
NO
If No, please explain the restriction:
Do you have key-person life insurance on yourself or other principals?
No
Have you identified who should control or own the business if you retire, become incapacitated, or pass away?
Yes
No
If Yes, who?
Has the business been formally valued within the last 3 years?
Yes
No
Do you have a target timeline for exiting or transitioning out of the business?
Yes
No
If Yes, target timeframe
Education & College Planning
Do you wish to fund education expenses for children and/or grandchildren?
Yes
No
Do you currently have any 529 Plans, Coverdell ESAs, or UTMA/UGMA accounts established?
Yes
No
If Yes, list account(s) and beneficiary(ies):
Estimated Total Education Funding Goal
Target Year(s) Funds Will Be Needed
Would you like to explore tax-advantaged education funding strategies as part of your plan?
Yes
No
Medicaid & Long-Term Care Planning
Do you have Long-Term Care insurance?
Yes
No
If Yes, carrier & benefit amount:
Would you like information on Medicaid planning and asset protection strategies?
Yes
No
Concerned About Future Cost of Long-Term Care?
Yes
No
Do you or your spouse have military service that may qualify for VA Aid & Attendance benefits?
YES
NO
Preferred Care Setting
Home
Assisted Living
Facility
Who Would You Want to Coordinate Your Care?
Tax Planning & History
Have you ever filed a Gift Tax Return (IRS Form 709)?
YES
NO
Are you concerned about your current income tax liability?
YES
NO
Are you concerned about potential estate or gift tax exposure at death?
YES
NO
Do you anticipate a significant change in income (sale of business or property, retirement, inheritance) in the next few years?
YES
NO
If Yes, please explain:
Are you interested in charitable giving strategies for tax benefit (donor-advised fund, charitable trust, etc.)?
YES
NO
Made Annual Exclusion Gifts to Family Members?
YES
NO
Have you made significant lifetime gifts beyond the annual exclusion amount?
YES
NO
If Yes, approximate total
Used Lifetime Gift / Estate Tax Exemption?
YES
NO
If Yes, approximate amount used:
Do you own or control any foreign trusts or foreign entities?
YES
NO
If Yes, please explain
Do you hold any foreign financial accounts (e.g., foreign bank or investment accounts)?
YES
NO
If Yes, please explain:
Has a portability election been made forYESa predeceased spouse's unused estate tax exemption?
YES
NO
Have you made any GST (generation-skipping transfer tax) exemption allocations?
NO
If Yes, please explain:
Which of the following are you most interested in discussing? (check all that apply)
Income Tax Planning
Estate/Gift Tax Planning
Business Tax Strategy
Charitable Planning
Roth Conversion Strategy
Not Sure / Need Guidance
Estate Planning Information — General
Have you ever been married before your current marriage?
YES
NO
Prior Marriage Ended How?
Divorce
Death of Spouse
Date
Do you have any obligations under a divorce decree from a prior marriage?
YES
NO
Please check any of the following community property states in which you have lived or acquired property during a marriage:
Arizona
California
Idaho
Louisiana
Nevada
New Mexico
Texas
Washington
Wisconsin
None
Have you ever received a substantial amount by inheritance?
YES
NO
If Yes, when and amount:
Do you anticipate receiving a substantial inheritance?
YES
NO
If Yes, approximate amount
Do you have a safe deposit box?
Yes
NO
If Yes, where?
Do you own property in a foreign country?
YES
NO
If Yes, where?
Do you have any relatives (other than your minor children) dependent upon you for support?
YES
NO
If Yes, who?
Are you concerned that one or more of your children/grandchildren will not behave responsibly with money that you give them?
YES
NO
Do you have a family member with special needs who may require lifetime financial support or a Special Needs Trust?
YES
NO
If Yes, please describe:
Real Estate Holdings
Real Estate Title & Structure
Provide the property manager, if any, and list any property you plan to sell within the next 5 years.
Which, if any, of these properties do you want transferred into your trust?
Financial Information
Cash Accounts
Brokerage Accounts & Securities
Notes & Mortgages Receivable
Tangible Personal Property
Liabilities
Beneficiary Designations
Life Insurance Policies
Digital Assets & Digital Property
Digital Property Types
Digital Assets / Accounts Description
Documents Client Can Provide
Other Documents You Plan to Provide
Estate-Planning Elections
The choices below are the actual dispositive, fiduciary, incapacity, and end-of-life decisions that will be reflected in your trust, will, power of attorney, and health care documents. This section is reviewed by your attorney.
Personal Representative
Trustee Choices
Financial Power of Attorney Agent Choices
Health Care Agent Choices
Guardian Choices
Digital Executor Choices
Trustee Structure
Trustee Structure
Corporate Trustee / Co-Trustee Details
Estate Distribution Instructions
Children / Descendants Distribution Method
Outright
In Trust
Trust Distribution Ages / Milestone
Lifetime Asset-Protection Trusts Preferred?
Yes
No
Special Beneficiary Protective Provisions
Beneficiary Protection Reasons
Creditor Concerns
Divorce Risk
Substance Abuse Concerns
Disability
Government Benefit Eligibility
Financial Immaturity
Other
Protected Beneficiary Details
Surviving Spouse Distribution
Outright
In Trust
Spouse May Continue Living in Family Residence?
Yes
No
Spouse Rights Change Upon Remarriage?
Yes
No
Preserve Assets for Descendants After Spouse Lifetime?
Yes
No
Specific Gifts & Bequests
Financial POA Effective
Immediately
Upon Incapacity
Please indicate which of the following powers you want your agent to have (check all that apply):
Should your health care agent's authority begin immediately, or only upon incapacity?
Immediately
Upon Incapacity
In a Terminal Condition, do you want life-prolonging treatment withheld/withdrawn, or continued?
Withhold or Withdraw
Continue
In a Persistent Vegetative State, do you want life-prolonging treatment withheld/withdrawn, or continued?
Withhold or Withdraw
Continue
In an End-Stage Condition, do you want life-prolonging treatment withheld/withdrawn, or continued?
Withhold or Withdraw
Continue
Do you want artificial nutrition and hydration provided in these circumstances?
Provide
Withhold
Do you wish to be an organ donor?
Yes
No
Do you prefer burial or cremation?
Burial
Cremation
Funeral / Memorial Preferences
Person Authorized to Control Disposition of Remains
Disposition Authorized Person Relationship
Trust Funding Intentions
Would you like assistance actually funding your trust (retitling assets into the trust's name)?
Yes
No
if Yes, which assets do you expect to transfer?
Please check your top priorities for this estate plan (check all that apply):
Is there anything unusual about your family, beneficiaries, assets, business interests, tax situation, health-care wishes, or planning objectives that you believe your attorney should know before reviewing your estate plan?