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.
FULL NAME (INCLUDING MIDDLE NAME)
DATE OF BIRTH
WIFE'S FULL NAME
MARRIAGE DATE (IF APPLICABLE)
QUESTIONS FOR INDIVIDUAL OR BOTH SPOUSES TOGETHER
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?
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:
WILL YOUR TRUSTEE ALSO BE YOUR: POWER OF ATTORNEY,
WILL EXECUTOR and MEDICAL AGENT?
Please answer questions below to help us understand
you (or your spouse) receiving Social Security, disability, or other governmental benefits?
you (or your spouse) ever filed federal or state gift tax returns?
(you or your spouse) completed previous will, trust, or estate planning? Please furnish copies of these documents
you wish to be Buried or Cremated?
you have specific Successor Trustees in mind?
List FULL NAMES of Successor Trustees in order HERE:
you need to qualify for Medicaid?
ADDITIONAL RELEVANT INFORMATION
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?
and Personal Effects
ADDITIONAL PERSONAL EFFECTS:
Boats and RVs
Bank & Savings
Stocks and Bonds
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:
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.
owed to you AND/OR OTHER ASSETS
TYPE: Mortgages or promissory notes
payable to you, or other moneys owed to you.
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?
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.