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Section 1: Personal Information

Name

First Middle Last

Date of Birth

Place of Birth

SSN

U.S. Citizen

Yes

Other Names Known by:

Are you presently employed? f Yes, for how long?

Occupation (former if retired):

Employer:

Business Address:

Office Phone:

Cell Phone:

Fax No.:

Email Address:

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other Residences:

Section 2 General Questions

Do you have an existing Trust?

Yes

If Yes, please provide a copy

Are you planning on getting married soon?

Yes

If Yes, please provide a copy

Have you previously been married?

Widowed

Divorced

If divorced, please describe on a separate sheet any continuing obligations under a divorce decree and attach a copy of pertinent paperwork if available.

Do you have an existing Will?

Yes

If Yes, would you like to discuss the advisability of a PrenuptialAgreement?

Yes

Please indicate your state of domicile and the date established. If you spend more than a nominal amount of time in another state or country, please identify.

Do you have relatives dependent upon you for support?

Yes

If Yes, give names and relationships:

Please list any specific items or amounts that you wish to give to any individuals or organizations at your death:

All other tangible personal property (automobiles, clothing, furniture, pictures, etc.) to be distributed to:

Children

Other

If Other (specify):

Do you want a Living Will to address end of life issues?

Yes

Who will serve as Executor for you?

Please leave Name, City/State, Relation and Gender

Who will serve as Trustee for you?

Please leave Name, City/State, Relation and Gender

Who will serve as Agent under a durable power of attorney (if desired)?

Please leave Name, Address, City/State, Zip, Relation and Gender

Who will serve as Health Care Surrogate/Agent (person to make medical decisions)?

Please leave Name, Phone, Address, City/State, Zip, Relation and Gender

Do you want a Living Will to address end of life issues?

Yes

Do you wish to be cremated?

Yes

Specify if needed:

Are you an organ donor?

Yes

Yes, but only as listed below

If Yes, please provide details of the disposition of your ashes, directing if they are to be scattered or preserved in one location.

Are you concerned that any of your beneficiaries will not behave responsibly with money that you give them?

Yes

Do you have pets for which you would like to make special provisions (such as custodial or financial arrangements)?

Yes

How did you first learn about our firm?

Section 3: Beneficiary Information

Names of living children as they are to appear in your documents

Name

Date of Birth

Phone

Address

Gender (male or Female)

Nationality of child:

Married? If Yes, please provide name of child's spouse:

Grandchildren? If Yes, please provide names and ages below:

Section 4: Digital Footprint

Do you wish to make specific gifts (or other disposition) of your digital assets?

Yes

Do you have any electronic and/or digital assets of significant value, whether stored externally or on your devices? These might include digital currency, intellectual property, or literary works.

Yes

Do you want some or all of your digital assets to be preserved at your death, instead of allowing the accounts and their content to be deleted?

Yes, preserve

Do you use an electronic service containing a list of your accounts and/or passwords?

Yes

Does anyone currently have access to your online accounts and/or passwords, or will they at your death?

Yes

If yes, who

Do you want to appoint someone to serve as your “Digital Fiduciary,” i.e., to deal with your digital

Yes

If yes, who

Section 5: Professional advisors

Attorney(s)

Name and Firm

Address

Phone

Financial Consultant

Name and Firm

Address

Phone

Accountant

Name and Firm

Address

Phone

Insurance Agent

Name and Firm

Address

Phone

Trust Officer

Name and Firm

Address

Phone

Other

Name and Firm

Address

Phone

Do we have your permission to discuss your plan and personal information with these advisors?

Yes

Addendum for Noncitizen Clients (Optional)

Name

First Middle Last

Country of Citizenship

Other Nationalities

Residency/Visa Status

Permanent Resident

Other

If you have a green card, when was it obtained? When does it expire?

Have you ever expatriated from the U.S., i.e., were you ever a US citizen or long term green card holder (8 out of 15 years)?

Yes

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(888) 871-9376

The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship.

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