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Estate Planning Intake
Please complete the following information and return to our office at your earliest convenience before your consultation.
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Email
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Your email
Full Name
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Your answer
Email Address
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Your answer
Date of Birth
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YYYY
Address
Your answer
Phone Number (best for contact)
Your answer
Name of Employer
Your answer
Occupation/Job Title
Your answer
Have you ever done any estate planning in the past?
Yes
No
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If so, please list which documents you have below and forward a copy to our office.
Your answer
Are you a Florida resident?
Yes
No
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What county do you reside in?
Broward
Miami-Dade
Other:
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Marital Status
Single
Married
Divorced
Widowed
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Spouse name
Your answer
Are you retired?
Yes
No
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What is your place of birth?
Your answer
What are your parent's names?
Your answer
Please list all Children, Next of Kin and their relationship to you, that would be beneficiaries of your estate. Please give date of birth for any minors.
Your answer
Are any of you children adopted?
Yes
No
N/A
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Have you made any funeral arrangements?
Yes
No
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If so, please list them below.
Your answer
Who would you like to serve as your personal representative? Please list name, relationship and address of the individual.
Your answer
Please list an alternate personal representative in the event the person name above is not able to serve. (please provide same info as above)
Your answer
Do you have personal items, property, gifts, etc. that you would like to leave specific people? If so, please list item, name and address of the individual.
Your answer
To whom would you like to receive the balance of your estate? If more than one beneficiary, please list the portions you are leaving them in percentages.
Your answer
Do you have any beneficiaries that have special needs?
Yes
No
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If so, please explain below.
Your answer
Would you like information regarding a Living Will?
Yes
No
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Would you like information regarding a Durable Power of Attorney?
Yes
No
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Would you like information regarding a Living Trust?
Yes
No
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Would you like information regarding a Health Care Surrogate?
Yes
No
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Please list all bank accounts you have and provide the name of bank and type of account.
Your answer
Do you have a safe deposit box?
Yes
No
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Do you own any real estate?
Yes
No
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If yes, please provide the type of real estate (home, land, other), location of property, name(s) on deed, and approximate value.
Your answer
Do you have any insurance policies?
Yes
No
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If so, please list the name of the company, any beneficiaries designated, and the policy value.
Your answer
Please list the names of any company with which you have stocks and/or bonds.
Your answer
Have you made any gifts over for which you had to file a gift tax return?
Yes
No
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Are you the beneficiary of any trust?
Yes
No
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Do you have any debts which are secured by assets (auto loan, real estate mortgage, etc.)? If so please list below.
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Do you own automobiles? If so, please list below and the name on the title of the vehicle.
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If there is any other information you would like to provide to help prepare for your consultation, please do so below.
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