Estate Planning Intake Form
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Table of Contents (click the link to jump to each section)

Personal Information
Employment Information
Spouse / Partner Information
Intended Beneficiaries
Children
Other Family Members
Advisors
Your Concerns

Important Family Questions
Assignments
Medical Preferences
Aging & Incapacity Preferences
Personal Property
Specific Gifts
Spousal Distribution
Trust Distribution

Date
Year Month Day
Date
File Name
Folder Name
Client Name
Scope
Fee Type
Retainer Flat Fee Evergreen Retainer
Retainer Amount
Evergreen Retainer Amount
Flat Fee Amount
Completion Method*
Electronic Print
Personal Information
Full Legal Name*
First Name Middle Name Last Name
Also Known As
Prefer to be Called
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.
It is okay to communicate with me via my email address.
Home Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Date of Birth*
Month Day Year
Date
Social Security Number
US Citizen?*
Yes No
Marital Status*
Single Married Domestic Partnership Divorced Widowed
Married?
Yes No
Employment Information
Employment Status
Employed Self-Employed Retired Unemployed Other
Employer
Position
Business Phone
Please enter a valid phone number.
Business Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Spouse / Partner Information
Spouse / Partner Header
Full Legal Name
First Name Middle Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
It is okay to communicate with me via my email address.
Home Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Date of Marriage
Month Day Year
Date
Is this domestic partnership certified?
Yes No
Upload Certificate of Domestic Partnership
Cancelof
Also Known As
Prefer to be Called
Date of Birth
Month Day Year
Date
Social Security Number
US Citizen?
Yes No
Employment Information
Spouse / Partner Employment Header
Employment Status
Employed Self-Employed Retired Unemployed Other
Employer
Position
Business Phone
Please enter a valid phone number.
Business Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Intended Beneficiaries (Primary and Contingent)
Please include all possible beneficiaries below, even if you are unsure, in case we decide to choose them after our planning meeting together to discuss. Contingent beneficiaries would be back-up beneficiaries in the scenario where a primary beneficiary predeceases you.
Attach an additional sheet for more rows
Full Legal Name DOB Relationship to Primary Home Address Comments
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Children
Do you have children?*
Yes No
If you have children, and are omitting any children, please list which child(ren) and the reasons below.
Do you intend on having or adopting children?
Yes No
Attach an additional sheet for more rows
Full Legal Name DOB Parents (primary, spouse/partner, both) Home Address Comments
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Other Family Members
Any other family members that don't fall under other categories in this form to consider in your estate plan. If you want to make sure a family member is specifically omitted please list them and indicate the same in the comments.
Attach an additional sheet for more rows
Full Legal Name DOB Relationship to Primary Home Address Comments
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Do you have additional family members to list?
Advisors
Do you have any advisors to list below?
Yes No
Personal Attorney
First Name Last Name
Personal Attorney Phone Number
Please enter a valid phone number.
Personal Attorney Email
example@example.com
Permission to contact them if needed in regard to your estate planning?
Yes No Other
Accountant
First Name Last Name
Accountant Email
example@example.com
Accountant Phone Number
Please enter a valid phone number.
Permission to contact them if needed in regard to your estate planning?
Yes No Other
Financial Advisor
First Name Last Name
Financial Advisor Phone Number
Please enter a valid phone number.
Financial Advisor Email
example@example.com
Permission to contact them if needed in regard to your estate planning?
Yes No Other
Life Insurance Agent
First Name Last Name
Life Insurance Agent Email
example@example.com
Life Insurance Agent Phone Number
Please enter a valid phone number.
Permission to contact them if needed in regard to your estate planning?
Yes No Other
Your Concerns
(Rate as High, Some, Low, None, or N/A)
Getting affairs in order and creating a comprehensive plan to manage affairs in case of death or disability:
High Some Low None N/A
Providing for and protecting a spouse/partner:
High Some Low None N/A
Providing for and protecting children:
High Some Low None N/A
Providing for and protecting grandchildren:
High Some Low None N/A
Disinheriting a family member:
High Some Low None N/A
Providing for charities at the time of death:
High Some Low None N/A
Planning for the transfer and survival of a family business:
High Some Low None N/A
Avoiding or reducing your estate taxes:
High Some Low None N/A
Avoiding probate:
High Some Low None N/A
Reducing administration costs at your time of death:
High Some Low None N/A
Avoiding a guardianship in case of disability:
High Some Low None N/A
Avoiding will contests or other disputes upon death:
High Some Low None N/A
Protecting assets from lawsuits or creditors:
High Some Low None N/A
Preserving the privacy of affairs in case of disability or at the time of death from business competitors, predators, dishonest persons, and curiosity seekers:
High Some Low None N/A
Planning for a child with disabilities or special needs such as medical or learning disabilities:
High Some Low None N/A
Protecting children's inheritance in the event of a surviving spouse's / partner's remarriage / marriage:
High Some Low None N/A
Protecting children's inheritance from the possibility of failed marriages:
High Some Low None N/A
Providing that your death shall not be unnecessarily prolonged by artificial means or measures:
High Some Low None N/A
Other concerns (if applicable):
High Some Low None N/A
Other concerns:
Important Family Questions
Or Spouse
Are you {orSpouse}receiving social security, disability, or other governmental benefits?
Social Security Disability Other
Describe other income:
Are you {orSpouse}making payments pursuant to a divorce or property settlement order?
Yes No
Please upload a copy of your divorce or property settlement order:
Cancelof
Have you and your spouse signed a pre- or post-marriage contract?
Yes No
Please upload a copy of your pre- or post-marriage contract:
Cancelof
Have you {orSpouse}been widowed?
Yes No
Please upload a copy of the federal estate tax return or state death tax return:
Cancelof
Have you {orSpouse}ever filed federal or state gift tax returns?
Yes No I am not sure
Please upload a copy of these returns:
Cancelof
Have you {orSpouse}completed previous will, trust, or estate planning?
Yes No
Please upload a copy of these documents:
Cancelof
Submission Notification
Do you {orSpouse}support any charitable organizations now that you wish to make provisions for at the time of your death?
Yes No I am not sure
Please explain:
Are there any other charitable organizations that you {orSpouse}don't currently support, but wish to make provisions for at the time of your death?
Yes No
Please explain:
Have you {orSpouse}lived in any of the following states while married? - AZ, CA, ID, LA, NV, NM, TX, WA, WI
Yes No
Are you {orSpouse}currently the beneficiary of anyone else's trust?
Yes No
Please explain:
Do any of your children have special educational, medical, or physical needs?
Yes No
Do any of your children receive government support or benefits?
Yes No
Do you {orSpouse} provide primary or other major financial support to adult children or others?
Yes No
Additional Information
Assignments
Please list in order of preference. Click + to add additional rows in each section. You must list at least one preference and one back-up to the primary choice.
Guardians for Minor Children; Attach an additional sheet for more rows
Full Legal Name Phone # Relationship to Primary Home Address
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Guardians for Minor Children
Trustees; Attach an additional sheet for more rows
Full Legal Name Phone # Relationship to Primary Type (Initial / Disability / Death) Primary Address Phone Number Email
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Trustees
Healthcare and Financial Agents; Attach an additional sheet for more rows
Full Legal Name Phone # Relationship to Primary Type (Healthcare/ Financial) Instructions or Guidelines Authorized to Make Gifts on Your Behalf? Giving Details
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Healthcare and Financial Agents
Medical Preferences
Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Yes No I would like help deciding
Do you want to provide that your organs and tissues should be made available for transplant purposes?
Yes No I would like help deciding
Do you want to provide that upon certification by two (2) physicians of need for psychological or substance treatment agent may arrange for voluntary admission?
Yes No I would like help deciding
Aging & Incapacity Preferences
Do you want to authorize your medical agent to take whatever steps necessary to keep you in a personal residence rather than a nursing home?
Yes No
In making distributions during any period of time you are incapacitated, the successor trustee shall give primary consideration to:
Your needs, then the needs of others dependent on you Your needs and the needs of others depending upon you equally
In making distributions during any period of time you or your spouse are incapacitated, the successor trustee shall give primary consideration to:
Disabled spouse's needs, then the needs of others Disabled and other spouse's needs, then the needs of others Disabled spouse's needs and the needs of others equally
Personal Property
Any movable thing or intangible item of value that is capable of being owned by a person and not recognized as real property.
Do you want to provide that your personal property will be distributed pursuant to a written list that you may prepare later?
Yes No
Any property not listed on the memorandum should be distributed to:
Balance of trust Other named individuals
Any property not listed on the memorandum should be distributed to:
Children equally Balance of trust Other named individuals
Any property not listed on the memorandum should be distributed to:
Spouse / partner, then to balance of trust Spouse / partner, then other named individuals Balance of trust Other named individuals
Any property not listed on the memorandum should be distributed to:
Spouse / partner, then children equally Children Spouse / partner, then to balance of trust Balance of trust Spouse / partner, then other named individuals Other named individuals
Please list other named individuals:
Specific Gifts
Attach an additional sheet for more rows
Dollar amount or Description of Property Individual or Charity name Property Ownership (individual / joint) Contingent upon spouse/partner pre-deceasing?
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Do you have specific gifts you'd like to make?
Yes No I would like help making this decision
Spousal Distribution
Upon the death of first spouse, assets should pass:
To surviving spouse without tax planning Divide into marital and family trusts
Spouse Distribution
All to surviving spouse % to surviving spouse Minimum allowed by law to surviving spouse
% to surviving spouse
Marital Deduction Formula
Disclaimer Provision Clayton Election Marital Pecuniary Marital Fractional Credit Shelter Pecuniary
Trust Distribution
Designation of Marital Share
Outright General appointment trust All income - principal for needs Only income Limited power of appointment Unsure
Designation of Family Share
All income - principal for needs Income and principal for needs Only income Unsure
Who is responsible for determining lifetime distributions?
Surviving spouse has the right to determine a co-trustee Designate co-trustees
Names of Co-Trustees
Do you want the surviving spouse to be able to modify the way property is distributed upon the surviving spouse's death?
Yes No
To whom may the surviving spouse distribute your property?
Your descendants Your descendants and their spouses Your descendants and charities Your descendants, their spouses, and charities Anyone, no limitations
Division of property upon death of second spouse to die:
Divide equally between children and descendants of deceased children Divide among named individuals and charities
Division of property:
Divide equally between children and descendants of deceased children Divide among named individuals and charities
Divide property among these individuals and charities:
Named individuals and charities; Attach an additional sheet for more rows
Name Percentage
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How and when to distribute my property:
Distribute outright to beneficiaries Structured trust Unsure
Notes regarding how and when to distribute my property
List your desires for trust distribution:
Remote Contingent Beneficiaries:
To my heirs-at-law To the following individuals or charities Unsure
Remote Contingent Beneficiaries:
To each spouse's heirs-at-law One half to clients's heirs-at-law and one half to spouse's heirs-at-law To my heirs-at-law To the following individuals or charities Unsure
Remote Contingent Beneficiaries; Add an additional sheet for more rows
Name Percentage
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Other Items to Discuss
Please Read: Please click "Submit" to save your answers. You will be redirected to the "Assets & Liabilities Worksheet."
Instruction regarding editing this form and next form: You will also receive a confirmation email with a link to return to this form to edit your answers or add additional information as well as a link to the "Assets & Liabilities Worksheet" to fill that form if you are unable to complete it now.
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	Full Legal Name	DOB	Relationship to Primary	Home Address	Comments
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	Full Legal Name	DOB	Parents (primary, spouse/partner, both)	Home Address	Comments
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	Full Legal Name	DOB	Relationship to Primary	Home Address	Comments
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	Full Legal Name	Phone #	Relationship to Primary	Home Address
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Estate Planning Intake Form

Personal Information

Employment Information

Spouse / Partner Information

Employment Information

Intended Beneficiaries (Primary and Contingent)

Children

Other Family Members

Advisors

Your Concerns

Important Family Questions

Assignments

Medical Preferences

Aging & Incapacity Preferences

Personal Property

Specific Gifts

Spousal Distribution

Trust Distribution