HOMEJON A. ZAHABY, ESQ.REAL ESTATE & TRUSTS BLOGESTATE PLANNING INTAKE WORKSHEETCONTACT USPAYMENT

Welcome to our "Simplified" Online Estate Planning Intake Form.  We know there are many questions, however, please answer to the best of your ability as this form will give us a good understanding of your Wishes, Family and your Estate.

HUSBAND OR INDIVIDUAL INFORMATION:

WIFE'S INFORMATION:

FULL NAME (INCLUDING MIDDLE NAME)

DATE OF BIRTH

 * required

US CITIZEN?

HOME ADDRESS

WIFE'S FULL NAME

DATE OF BIRTH

US CITIZEN?

MARRIAGE DATE (IF APPLICABLE)

 

EMAIL ADDRESS

EMAIL ADDRESS

QUESTIONS FOR INDIVIDUAL OR BOTH SPOUSES TOGETHER

CHILDREN AND BENEFICIARIES

GUARDIAN FOR MINOR CHILDREN:  If you have any children under the age of 18, list in order of preference who you wish to be guardian.

DO YOU HAVE CHILDREN?

LIST INITIAL TRUSTEE(S): Usually the Maker will be the Trustee of his or her own trust.  Often, both spouses, jointly.  Allows you to continue to jointly control your assets as before.

ADVISORS:
(Please list any CPA, Financial Planner or Life Insurance Agent that you are working with along with contact information)

DO YOU NEED TAX PLANNING? (You will need to schedule a meeting with Mr. Zahaby if Yes)

PLEASE LIST YOUR CHILDREN'S FULL NAMES ALONG WITH DATE OF BIRTH HERE:

(Use full legal name. Use “JT” if both spouses are the parents, “H” if husband is the parent, “W” if wife is the parent, “S” if a single parent.)

WILL YOUR TRUSTEE ALSO BE YOUR:  POWER OF ATTORNEY, WILL EXECUTOR and MEDICAL AGENT?

Please answer questions below to help us understand your Estate.

Are you (or your spouse) receiving Social Security, disability, or other governmental benefits?

Have you (or your spouse) ever filed federal or state gift tax returns?      

Have (you or your spouse) completed previous will, trust, or estate planning? Please furnish copies of these documents

Do you wish to be Buried or Cremated?

Do you have specific Successor Trustees in mind?

List FULL NAMES of Successor Trustees in order HERE: 

Do you need to qualify for Medicaid?

Do you (or your Spouse) have a Chronic Illness?

ADDITIONAL RELEVANT INFORMATION

real property

TYPE:  Any interest in real estate including your family residence, vacation home, time share, vacant land, etc.

 

DO ANY OF THE PROPERTIES THAT YOU LISTED HAVE OVER ONE (1) MILLION DOLLARS IN EQUITY?

Furniture and Personal Effects

TYPE:  List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (indicate type below and give a lump sum value for miscellaneous, less valuable items.).

ADDITIONAL PERSONAL EFFECTS:

Automobiles, Boats and RVs

TYPE:  For each motor vehicle, boat, RV, etc. please list the following: description, how titled, market value and encumbrance:

ADDITIONAL VEHICLES:

Bank & Savings accounts

TYPE:  Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s here

ADDITIONAL ACCOUNTS:

Stocks and Bonds

TYPE:  List any and all stocks and bonds you own.  If held in a brokerage account, lump them together under each account.   (indicate type below)

ADDITIONAL SECURITIES:

Life Insurance Polices and ANNUITIES

TYPE:  Term, whole life, split dollar, group life, annuity.  ADDITIONAL INFORMATION:  Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.

ADDITIONAL INSURANCE PRODUCTS:

Retirement Plans

TYPE:  Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K).  ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.

 

Business Interests

TYPE:  General and Limited Partnerships, Sole Proprietorships, privately owned corporations, professional corporations, oil interests, farm and ranch interests.  ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

 

Money owed to you AND/OR OTHER ASSETS

TYPE:  Mortgages or promissory notes payable to you, or other moneys owed to you.

TYPE:  Other property is any property that you have that does not fit into any listed category.

 

Total Assets: (please calculate the total value of your estate)

HOW DO YOU WANT YOUR ASSETS DISTRIBUTED?

DIVIDE EQUALLY BETWEEN OUR CHILDREN AND THE DESCENDANTS OF ANY DECEASED CHILDREN
DIVIDE AMONG BELOW NAMED INDIVIDUALS and/or CHARITIES

This is a simplified intake sheet for online convenience.  If you feel you have answered to the best of your ability click the SUBMIT button to the left.  Jon A. Zahaby, Esq. will contact you by email or telephone to assist you in answering any unanswered questions.

Please print out form for your records.

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