WILL INTAKE SHEET

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WILL INTAKE SHEET

Intake Date: _______________________

Client’s Full Name:

CONTACT INFORMATION:

Telephone No.:

Alt. Telephone No.:

Fax No.:

E-mail address:

Mailing Address:

Dates at current address:

Date of birth:

MARITAL STATUS:

( ) Single ( ) Married ( ) Widowed ( ) Divorced ( ) Separated

Spouse’s name:

Spouse’s date of birth:

Citizenship (if other than U.S.):

Wife:

Husband:

Former marriages? Husband: ( ) Yes ( ) No Wife: ( ) Yes ( ) No

CHILDREN & OTHER PERSONS TO BE CONSIDERED:

Children of current marriage (including legally adopted children):

Name:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children: Ages:

Children of Husband’s former marriage (including legally adopted children):

Name:

Birthdate: Sex:

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Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children: Ages:

Children of Wife’s former marriage (including legally adopted children):

Name:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children: Ages: Name:

Birthdate: Sex:

Are they married? ( ) Yes ( ) No # of Children:

Deceased Children:

Name:

Ages:

Birthdate: Sex:

Were they married? ( ) Yes ( ) No # of Children:

Name:

Ages:

Birthdate: Sex:

Were they married? ( ) Yes ( ) No # of Children: Ages:

Other People to be considered in your Estate:

Name:

Age: Sex: Relationship:

Name:

Age: Sex: Relationship:

Name:

Age: Sex: Relationship:

Charitable Organizations you have supported or wish to support:

Name:

Address:

Name:

Address:

Military Service:

Service Serial Number:

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Branch of Service:

Dates of Service:

Veterans Administration Disability Number:

CURRENT WILLS & TRUSTS

Do you have an existing will or trust?

Date of will or trust:

If you have an existing will or trust please bring it to our

meeting.

EXECUTORS, TRUSTEES, OR GUARDIANS

Executor - the person who manages your estate. This is a person

that you should trust to fulfill the terms of your will and work

with your heirs. Generally, we prefer to have one person serve in

this position, but if needed multiple persons can serve as an

executor. A woman serving in this role is typically called an

executrix.

Trustee - the person who manages any trust that you might set

up. This is a person who would deal with the beneficiaries of any

trust you set up and fulfill the terms of your trust.

Guardian - the person who will manage assets for people who

are minors or otherwise can’t manage their affairs. This may also

refer to a person who becomes the custodian of your children in

the event of your death.

Primary Executors, Trustees or Guardians:

Name: Phone:

Address:

Name: Phone:

Address:

Secondary Executors, Trustees or Guardians

Name: Phone:

Address:

Name: Phone:

Address:

Bequests:

(note that anything not specifically mentioned will be put into the residuary and will

potentially be liquidated by the administrator of the estate).

General Bequests (dollar amount or percentage, subject to reduction if the money is

insufficient, but not ademption):

Specific Bequests (specific tangible items/property, subject to reduction, also subject to

loss; if the item doesn’t exist anymore, they get nothing to replace it):

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Residue and Remainder (what to do with everything that is left):

Contingency provision if a distributee is no longer alive:

Should things subject to a lien/mortgage or free of the debt? (cars, houses, etc.):

ITEMS TO BEQUEST

Real Estate:

Type:

Location (City, State):

Owner:

Type of Ownership:

Purchase Date:

( ) Mortgage ( )Lien ( )None

Bequest subject to mortgage/lien?

Type:

Location (City, State):

Owner:

Type of Ownership:

Purchase Date:

( ) Mortgage ( )Lien ( )None

Bequest subject to mortgage/lien?

Personal Property (cars, jewelry, valuables):

Item:

Locations:

Item:

Locations:

Item:

Locations:

Item:

Locations:

Liens? ( ) Yes ( ) No Which?

Bequest subject to lien?

Bank Accounts, Investments, 401(k), etc. (if specifically given out):

Type of Account:

Bank:

Type of Account:

Bank:

Type of Account:

Bank:

Type of Account:

Bank:

DEBTS

Other than mortgages or loans/liens on specific items, it is recommended that all taxes

fees and expenses be paid out of the estate prior to any distributions. Is this satisfactory?

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( ) Yes ( ) No

If any of your recipients or beneficiaries are under 18, do you want their share to be

placed in trust? ( ) Yes ( ) No

If so, until what age? (note the potential for exceptions; education, travel, annual

amounts, etc.) ___________________________________________

EXECUTORS & TRUSTEES

Designate an executor:

Name:

Address:

Alternate Executor?

Designate Trustee(s) for any trusts created:

Appointment of Guardian for children under 18:

Name:

Address:

Relationship:

Alternate:

Name:

Address:

Relationship:

Describe how you would like your estate to be distributed (including people to be expressly

excluded):

_________________________________________________________________________________________________________

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PERSONAL RECORDS WORKSHEET

(Other information you should compile and keep with your records)

Write the memorandum for your executor, for smaller things. Generally real property or

valuable tangibles get mentioned specifically in the will. Smaller things with more

sentimental value are more for the memorandum. Also include funeral wishes in it

Name:

Social Security Number: - -

Father’s Name:

Mother’s Name: Maiden Name:

Your Date of Birth: Father’s Date of Birth: Mother’s Date of Birth:

Spouses Date of Birth:

Location of Your Birth Certificate:

Location of Spouse’s Birth Certificate:

Location of Your Marriage Certificate:

Former Addresses:

Address #1 Address #2 Address #3

Dates of residence:

Military Service Serial Number:

Branch of Service: Dates of Service:

Veterans Administration Disability Number:

Location of will:

Name of Lawyer:

Address:

Phone: ( ) -

Name of Accountant:

Address:

Phone: ( ) -

Name of Financial Advisor:

Address:

Phone: ( ) -

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Location of past tax information:

INVENTORY OF ASSETS

**************************************

PLEASE NOTE: ALL THE INFORMATION BELOW IS VERY SENSITIVE

AND SHOULD NOT BE STORED IN AN EASILY ACCESSIBLE LOCATION

FOR PRIVACY REASONS. ADDITIONALLY THIS INFORMATION SHOULD

BE DESTROYED RATHER THAN THROWN OUT IF EVER DISPOSED OF. IF

THERE IS ANY DOUBT AS TO THE SECURITY OF THIS FORM, DO NOT

FILL OUT ALL OF THE INFORMATION BELOW.

**************************************

Safety Deposit Boxes:

Name & Address of Bank:

Box Number: Location of Key:

Held Jointly with (Name & Address):

Additional people with Access to the box (name & address):

Name & Address of Bank:

Box Number: Location of Key:

Held Jointly with (Name & Address):

Additional people with Access to the box (name & address):

Stored Property

Name and Address of Storage Facility:

Storage Unit #:

Access Code: (It is not advised to write down passwords or access codes or pin numbers

but it would be helpful if someone else knew the access code if you are unavailable)

Location of Personal Safe:

Access Code: (It is not advised to write down passwords or access codes or pin numbers

but it would be helpful if someone trustworthy knew the access code if you are

unavailable)

Credit Cards:

Company:

Number:

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Banking Information:

Bank Name:

Address

Account:

Names on Account:

Bank Name:

Address

Account:

Names on Account:

Bank Name:

Address

Account:

Names on Account:

Investment or Money Market Accounts

Bank Name:

Address

Account:

Names on Account:

Bank Name:

Address

Account:

Names on Account:

Certificates of Deposit:

Bank Name:

Address

Account:

Names on Account:

Bank Name:

Address

Account:

Names on Account:

Life Insurance

Company:

Beneficiary:

Policy Number:

Owner:

Secondary Beneficiary:

Death Benefit: $

Company:

Beneficiary:

Owner:

Secondary Beneficiary:

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Policy Number: Death Benefit: $

Company:

Beneficiary:

Policy Number:

Owner:

Secondary Beneficiary:

Death Benefit: $

Homeowners Insurance:

Property Address:

Company: Policy Number:

Location of Policy:

Property Address:

Company: Policy Number:

Location of Policy:

Automobile Insurance:

Vehicle #1 Make & Model:

Company: Policy Number:

Location of Policy:

Vehicle #2 Make & Model:

Company: Policy Number:

Location of Policy:

Other Insurance:

Type:

Policy Number:

Company:

Location of Policy:

Policies owned on other persons:

Name:

Policy Number:

Company:

Location of Policy:

Loans against any policy:

Company: Amount: $

Location of Records:

Marketable Securities (Stocks, bonds, mutual funds, etc.):

Company:

Owner:

Original Cost: $

Type:

Number of Shares:

Current Value: $

Company:

Owner:

Original Cost: $

Type:

Number of Shares:

Current Value: $

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Company:

Owner:

Original Cost: $

Type:

Number of Shares:

Current Value: $

Company:

Owner:

Original Cost: $

Type:

Number of Shares:

Current Value: $

Retirement Plans/Employee Benefits:

Individual Retirement Account:

Owner:

Value: $

Beneficiary:

401(k), 403(b) Plans:

Owner:

Value: $

Beneficiary:

Tax Deferred Annuity:

Owner:

Value: $

Beneficiary:

Qualified Pension, KEOGH or Profit Sharing Plan:

Owner:

Value: $

Beneficiary:

Deferred Compensation Plan:

Owner:

Value: $

Beneficiary:

Split Dollar, Stock Options or Thrift Plans:

Owner:

Value: $

Beneficiary:

Roth IRA:

Owner:

Value: $

Beneficiary:

Disability Policies:

Owner:

Value: $

Beneficiary:

Long Term Care Insurance Policies:

Owner:

Value: $

Beneficiary:

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Debts Owed to me:

Liabilities (loans, mortgages, notes, liens, etc.):

Type: Amount: $

Owned on What Property?

Type: Amount: $

Owned on What Property?

Type: Amount: $

Owned on What Property?

Type: Amount: $

Owned on What Property?

Type: Amount: $

Owned on What Property?

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MEMORANDUM FOR EXECUTOR:

(include this information in addition to property distribution wishes)

Religious Affiliation:

Name of Church/Synagogue/Mosque, etc:

Address:

Phone: ( )

Prepaid Burial Costs, if any:

Funeral Instructions, if any:

____________________________________________________________________________________

Obituary Wording:

Tombstone Engraving:

Cemetery Plot:

Name of Cemetery:

Address:

Phone: ( ) -

Location of deed:

Is there anyone you wish to be notified of your passing that you believe may not be

informed in a timely fashion?

Name: Phone:

Alt. Phone: Email:

Address:

Name: Phone:

Alt. Phone: Email:

Address:

Name: Phone:

Alt. Phone: Email:

Address:

Name: Phone:

Alt. Phone: Email:

Address:

SOCIAL MEDIA

Have you designated legacy contact (an individual who can access your accounts after

you pass away) for your social media accounts? If not, who would you like to designate

as your legacy contact?

__________________________________________________________________

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