Estate Planning Worksheet | Bryant Elder Law

Step 1 of 10

Information provided is held in complete confidence, and is used for the sole purpose of analyzing estate planning needs and designing estate planning documents. Completing this intake form is necessary in order for the 1-hour consultation to be tailored to your needs.

Date

Referred By

WHO IS THIS PLANNING FOR?

SPOUSE 1

Full legal name as written on government issued ID

First Middle Last

Preferred Name

Name

Phone

SPOUSE 2

Full legal name as written on government issued ID

First Middle Last

Preferred Name

Name

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code

IF YOU ARE COMPLETING THIS FORM FOR SOMEONE ELSE PLEASE PROVIDE YOUR CONTACT INFORMATION

Full legal name as written on government issued ID

First Middle Last

Relationship

Preferred Name

Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

SUCCESSOR TRUSTEES

Who is in charge of managing your trust if you die or become incapacitated? (List people in order of preference.)

1. Full legal name as written on government issued ID

First Middle Last

2. Full legal name as written on government issued ID

First Middle Last

3. Full legal name as written on government issued ID

First Middle Last

ADVANCE HEALTH CARE DIRECTIVE

Who is in charge if you cannot make your own health care decisions? We recommend at least 2 agents (list order of preference)

SPOUSE 1

SPOUSE 2 is AGENT 1 (If yes, please do not fill out the AGENT 1 section)

SPOUSE 2 is AGENT 2 (If yes, please do not fill out the AGENT 2 section)

SPOUSE 2 is AGENT 3 (If yes, please do not fill out the AGENT 3 section)

SPOUSE 2 IS NOT AN AGENT

AGENT 1: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

AGENT 2: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

AGENT 3: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

SPOUSE 2

SPOUSE 1 is AGENT 1 (If yes, please do not fill out the AGENT 1 section)

SPOUSE 1 is AGENT 2 (If yes, please do not fill out the AGENT 2 section)

SPOUSE 1 is AGENT 3 (If yes, please do not fill out the AGENT 3 section)

SPOUSE 1 IS NOT AN AGENT

AGENT 1: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

AGENT 2: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

AGENT 3: Full legal name as written on government issued ID

First Middle Last

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

POWER OF ATTORNEY

Who is in charge if you cannot make financial decisions? (List people in order of preference.)

SPOUSE 1: If you want the exact same people and order from your Advance Health Care Directive to apply to your Power of Attorney, check this box and skip this section.

Yes

SPOUSE 1

SPOUSE 2 is AGENT 1 (If yes, please do not fill out the AGENT 1 section)

SPOUSE 2 is AGENT 2 (If yes, please do not fill out the AGENT 2 section)

SPOUSE 2 IS NOT AN AGENT

AGENT 1: Full legal name as written on government issued ID

First Middle Last

County of Residence

AGENT 2: Full legal name as written on government issued ID

First Middle Last

County of Residence

SPOUSE 2: If you want the exact same people and order from your Advance Health Care Directive to apply to your Power of Attorney, check this box and skip this section.

Yes

SPOUSE 2

SPOUSE 1 is AGENT 1 (If yes, please do not fill out the AGENT 1 section)

SPOUSE 1 is AGENT 2 (If yes, please do not fill out the AGENT 2 section)

SPOUSE 1 IS NOT AN AGENT

AGENT 1: Full legal name as written on government issued ID

First Middle Last

County of residence:

AGENT 2: Full legal name as written on government issued ID

First Middle Last

County of Residence

SCHEDULE A FREE CONSULTATION

SCHEDULE A FREE CONSULTATION

ESTATE PLANNING WORKSHEET (COUPLE)

WHO IS THIS PLANNING FOR?

SPOUSE 1

SPOUSE 2

IF YOU ARE COMPLETING THIS FORM FOR SOMEONE ELSE PLEASE PROVIDE YOUR CONTACT INFORMATION

CHILDREN

PLEASE COMPLETE THIS SECTION IF YOU HAVE MINOR CHILDREN

SUCCESSOR TRUSTEES

ADVANCE HEALTH CARE DIRECTIVE

POWER OF ATTORNEY

DISTRIBUTION SCHEME

IF NO, THEN PLEASE FILL OUT THE CHART BELOW:

SPECIFIC GIFTS

Person Or Charity

Item Or Cash Amount

FINANCIAL INFORMATION

REAL PROPERTY

BANK ACCOUNTS

BROKERAGE ACCOUNTS

IRA's

ANNUITIES

PENSION AND/OR 401K

LIFE INSURANCE

DO YOU OWN A BUSINESS?

VEHICLES

DO YOU HAVE ANY QUESTIONS OR CONCERNS?

San Jose Office

San Mateo Office