MATHEWS LAW ESTATE PLANNING INTAKE FORM - Couple
Please complete the questions below.
Sign in to Google to save your progress. Learn more
Email *
Today's Date
MM
/
DD
/
YYYY
This form is for intake purposes only and does not create a client relationship with Mathews Law. All information provided is confidential.
Please state your name and your spouse's name.
Date of Birth - Wife
MM
/
DD
/
YYYY
Date of Birth - Husband
MM
/
DD
/
YYYY
What is your home address?
Please indicate the Wife's phone number.
Please indicate the Husband's phone number.
How many children do you have?
If you have children, please list the names and dates of birth for each child.
Please indicate if either of you have children from a different relationship and their names and dates of birth.
Do any members of your family or others have special needs which you like taken into consideration in your estate plan?
Clear selection
If you answered yes to the previous question, please explain.
Please indicate if either of you have any of the following assets:
In the space below, please indicate any other assets such as contents of a safe deposit box, jewelry, vintage cars, etc.
Are there any other assets (expected), debts, previously-given gifts, or any other financial information that should be taken into account in planning your estate plan? If yes, please explain.
If you have minor children, in the space below, please provide the name, address, phone number, and relationship of the person/people who should receive guardianship of your children if necessary. It is best to name a primary and alternate guardian.
If you have minor children, in the space below, please provide the name, address, phone number, and relationship of the person/people who should be trustee of your children’s trust assets if necessary. It is best to have a primary and alternate trustee.
In the space below, please provide the name, address, phone number, and relationship of the person who should act as the personal representative (executing your will) for each of you. It is best to have a primary and alternate personal representative.
In the space below, please provide the name, address, phone number, and relationship of the person who should act as the health care power of attorney for each of you. It is best to have a primary and alternate health care power of attorney.
In the space below, please provide the name, address, phone number, and relationship of the person who should act as the financial power of attorney for each of you. It is best to have a primary and alternate power of attorney.
In the space below, please provide the name, address, phone number, and relationship of the person who should act as your trustee (if you are creating a trust), if necessary. It is best to have a primary and alternate trustee.
In the space below, please indicate names, addresses, phone numbers, and relationships of each beneficiary (and percentages) of your estate (including charities if applicable). Please also indicate any special gifts or other specific instruction you would like included in your estate plan.
In the space below, please provide any other instruction that you would like addressed in your estate plan.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Mathews Law, PLLC. Report Abuse
Google Forms