MATHEWS LAW ESTATE PLANNING INTAKE FORM - Couple
Please complete the questions below.
Email address *
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.
Your answer
Date of Birth - Wife
MM
/
DD
/
YYYY
Date of Birth - Husband
MM
/
DD
/
YYYY
What is your home address?
Your answer
Please indicate the Wife's phone number.
Your answer
Please indicate the Husband's phone number.
Your answer
How many children do you have?
Your answer
If you have children, please list the names and dates of birth for each child.
Your answer
Please indicate if either of you have children from a different relationship and their names and dates of birth.
Your answer
Do any members of your family or others have special needs which you like taken into consideration in your estate plan?
If you answered yes to the previous question, please explain.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
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.
Your answer
In the space below, please provide any other instruction that you would like addressed in your estate plan.
Your answer
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