Estate Planning Worksheet (Single)

ESTATE PLANNING WORKSHEET (Single)

Step 1 of 9

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?

Full legal name as written on government issued ID

First Middle Last

Preferred Name

Name

Address

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

Phone Number

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 Number

SUCCESSOR TRUSTEES

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

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

POWER OF ATTORNEY

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

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

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

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

First Middle Last

County of Residence:

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