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Home
Who We Are
Services
Estate Planning
Living Trusts
Wills
Power Of Attorney
Medi-Cal Planning
Medi-Cal Planning Overview
Medi-Cal Planning for Married Couples
In-Home Support Services
Medi-Cal Recovery
Special Needs Planning
Special Needs Trusts
Conservatorships
Probate
Probate
Trust Administration
First Steps After Death
Resources
Testimonials
Blog
Contact
ESTATE PLANNING WORKSHEET (Single)
Step
1
of
9
11%
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
MM slash DD slash YYYY
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
Email
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
Email
CHILDREN
Name of Child/Children
Child’s Name (Full legal name as written on government-issued ID)
Address
Living (Yes/No)
Gender
Date Of Birth
Disabled (Yes/No)
Add
Remove
PLEASE COMPLETE THIS SECTION IF YOU HAVE MINOR CHILDREN
Who would you like to be guardian of your minor child/children? (List people in order of preference).
Primary (Full legal name as written on government issued ID)
First
Middle
Last
Phone Number
Backup (Full legal name as written on government issued ID)
First
Middle
Last
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:
DISTRIBUTION SCHEME
Who gets what? How would you like to distribute your estate upon your death?
Equal shares to children?
Yes
No
IF NO, THEN PLEASE FILL OUT THE CHART BELOW:
Beneficiary (Full legal name issued by government ID)
Example: Johnathan Roger Doe (not John Roger Doe)
Percentage %
Example: 1) 30% (David) 2) 70% (Jane) =100 %
Beneficiary
Percentage %
Add
Remove
If one of your beneficiaries predeceases you:
Their share goes to their children, OR
Their share gets distributed to the remaining beneficiaries
If you have a minor beneficiary his/her share should be held in the trust until:
Age 25, OR
Other (e.g., ½ at age 25 and the balance at age 30; 1/3 at age 21, 1/3 at age 25, 1/3 at 35):
Please provide details
SPECIFIC GIFTS
Do you want to make charitable gifts, such as to a house of worship or other institution? Do you wish to make a special gift, such as a piece of jewelry to a particular person? If so, please fill out the section below.
Person/Charity
Full legal name as written on government-issued ID OR Full Name of Charity (e.g., David John Doe; San Francisco SPCA)
Item/Cash Amount
(e.g., My Diamond Engagement Ring, $10,000.00)
Person/Charity
Item/Cash Amount
Add
Remove
FINANCIAL INFORMATION
Earned Monthly Income from Labor
Monthly Social Security Income
Monthly Pension Income
Other Monthly Income
REAL PROPERTY
Property types include Primary, Secondary, Additional, Rental, Vacation, Timeshare and Land.
Property
Type of Property (Primary, Rental, Vacation, Timeshare, Land)
Address
Add
Remove
BANK ACCOUNTS
Bank Accounts
Type of Account (Checking, Savings, Money Market)
Account Owner
Name of Bank
Current Amount
Add
Remove
BROKERAGE ACCOUNTS
Brokerage Accounts
Company Name
Account Owner
Current Amount
Add
Remove
IRA's
Investment Accounts
Company Name
Owner
Beneficiary
Value
Add
Remove
ANNUITIES
Annuities
Company Name
Account Owner
Current Monthly Payout
Add
Remove
PENSION AND/OR PROFIT SHARING
Pension And/Or Profit Sharing
Company Name
Account Owner
Payout
Add
Remove
LIFE INSURANCE
Life Insurance
Company Name
Type (Whole, Universal, or Term)
Owner
Beneficiary
Cash Value
Death Benefit
Add
Remove
DO YOU OWN A BUSINESS?
Do You Own A Business?
Business Name
Type (Sole Proprietorship, LLC, or Corporation)
EIN/TIN
Add
Remove
VEHICLES
How many vehicles do you own in total, including both individually-owned and jointly-owned vehicles?
DO YOU HAVE ANY QUESTIONS OR CONCERNS?
Our goal is to empower you through education. Please feel free to ask any questions regarding your estate plan in the box below.