Estate Planning Client Information "*" indicates required fields DemographicsToday's Date Month Day Year CLIENT #1Full Legal Name* NAME OF DECEDENT Middle Last Also Known As Marital Status Address STREET COUNTY CITY STATE ZIP Last 4 of Social Security Number PhoneEmail Birth YearCLIENT #2Full Legal Name NAME OF DECEDENT Middle Last Also Known As Marital Status Address STREET COUNTY CITY STATE ZIP Last 4 of Social Security Number PhoneEmail Birth YearPersonal Representative/Successor TrusteeCLIENT #1First Choice Full Name (Usually Spouse) NAME Middle Last Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneCLIENT #2First Choice Full Name (Usually Spouse) NAME Middle Last Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneChildrenUse + to add more lines.Full NameDate of BirthChild of (Client #1, #2 or both) Add RemoveGuardian & Successor Guardian for Minor ChildrenIf any children are minors, name a Guardian AND Successor Guardian for the child(ren). These are persons you appoint if your spouse is not alive.CLIENT #1First Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneCLIENT #2First Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Address STREET CITY STATE ZIP PhoneDisbursement of AssetsTypical Disbursement FIRST: All assets to spouse. SECOND (Choose 1): (a) If spouse is deceased, then all assets to children in equal shares. OR (b) If spouse is deceased and you have no children, then designate an heir and an alternate heir. THIRD (Choose 1): (a) If a child is deceased, then their share of the estate to their surviving children. OR (b) If a child is deceased, then their share split between surviving siblings. CLIENT #1First First Second First Third First CLIENT #2First First Second First Third First DisinheritanceSpecific BequestsDisposition of Remains/Funeral PlansDo you and your spouse (if applicable) have a Prenuptial Agreement? If so, please provide us with a copy.Financial Power of AttorneyCLIENT #1First Choice (Usually Spouse) NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneCLIENT #2First Choice (Usually Spouse) NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneMedical Power of Attorney/Patient Advocate Person who makes decision on life support issues. First choice is normally your spouse. CLIENT #1First Choice Full Name NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneCLIENT #2First Choice Full Name NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneSecond Choice Full Name NAME Middle Last Relationship Address STREET CITY STATE ZIP PhoneSpecial Medical Care InstructionsTypical Instructions If my physician believes that I have no reasonable expectation of recovery from an incurable or terminal injury, disease, or illness, and if my advocate determines, after consulting with my physician, that applying life-sustaining procedures would serve only to prolong life artificially, I authorize my advocate to direct that such procedures be withheld or withdrawn. Examples of life-sustaining procedures include surgery, drugs, renal dialysis, cardiopulmonary resuscitation, artificial feeding, and ventilators or respirators. I acknowledge that the decision to withhold or withdraw treatment could or would allow me to die. Under these circumstances, I want treatment limited to measures, medication, and hydration that will provide me with comfort and freedom from pain. Write "Typical" if above instructions are what you desire. Otherwise, write in the blanks what special instructions you wish to grant to your Patient Advocate.CLIENT #1CLIENT #2List of AssetsPlease list what the asset is, what company it is held with, who is on the account, and the beneficiaries named on the asset if applicable.USE + TO ADD MOREBANK/FINANCIAL ACCOUNTSIS A PAYABLE ON DEATH NAMED? Add RemoveUSE + TO ADD MORELIFE INSURANCEBENEFICIARY NAME Add RemoveUSE + TO ADD MORERETIREMENT ACCOUNTSBENEFICIARY NAME Add RemoveUSE + TO ADD MOREINVESTMENT ACCOUNTSBENEFICIARY NAME Add RemoveUSE + TO ADD MORELLC INTERESTSBENEFICIARY NAME Add RemoveAddresses of All Properties OwnedUse + to add more lines.AddressName(s) on DeedIs there a mortgage on property?How do you hold the title? Add RemoveNote: We will need a copy of the deed for any property owned if you anticipate a trust.Important Family QuestionsIf married, have you and your spouse signed a prenuptial agreement? If yes, please provide our office with a copy. Yes No Have you or your spouse previously had estate planning documents drafted? If yes, please provide our office with a copy. Yes No Are there any charitable organizations that you wish you make provisions for at the time of your death? Yes No If yes, please list them here. Do any of your children have any special educational, medical, or physical needs? Yes No Do any of your children receive governmental support or benefits? Yes No Are you or your spouse currently receiving social security, disability, or other governmental benefits? Yes No File Drop files here or Select files Max. file size: 100 MB. Name First Last Address STREET COUNTY CITY STATE ZIP Home PhoneCell PhoneWork PhoneEmail How Did You Hear About Us?PLEASE SELECT ONEALLEGAN COUNTY LEGAL ASSISITANCE CENTERFACEBOOKALLEGAN NEWSONLINE SEARCHREFERRED BYOTHERPlease Explain Type of CasePLEASE SELECT ONECRIMINALFAMILY LAWWILLS/TRUSTSLITIGATIONBANKRUPTCYSOCIAL SECURITYOTHERPlease Explain CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
