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ElDeiry & ElDeiry, P.A.

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Estate Planning Intake Form

Step 1 of 12

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Whose estate plan is this?
One Spouse on this page, Other Spouse is on next page
Full Name
First Last
U.S. Citizen?
- Yes
- No
Date of Birth
MM slash DD slash YYYY
Street Address
Street Address Apt. City State / County ZIP / Postal Code Country
Phone (Home)
Phone (Cell)
Phone (Work)
Email
Marital Status (select the most appropriate)
- Single, never married.
- Married currently, and my spouse is alive.
- Married, but my spouse predeceased me.
- Married now, and was previously married and divorced
- Divorced, and not presently married.
Date of Dissolution

NOTE: If you have been divorced, please provide a copy of your Divorce Decree.
If applicable, have you and your spouse signed a pre-marital agreement?

If so, please provide a copy of the agreement.
NOTE: If you have been divorced, please provide a copy of your Divorce Decree.
Have you ever served in the military?
- Yes
- No
Have you guaranteed any loans for your children or any other person?
- Yes
- No
If so, in what amount?
Testator’s Spouse (if applicable)
Full Name
First Last
U.S. Citizen?
- Yes
- No
Date of Birth
MM slash DD slash YYYY
Address
Street Address Apt. City State/County ZIP / Postal Code Country
Phone (Home)
Phone (Cell)
Phone (Work)
Email

Are any of your children adopted?
Does your spouse have children that are not your biological children and that you have not adopted?

Note: Your spouse’s children (that you have not legally adopted) will not inherit from you unless you’ve included them in your Will.
If applicable, do you want to include your spouse’s children in your estate planning documents?
Are any of your children deceased?
Have any children received an advance on their inheritance or are any children financially indebted to you – ie – have you loaned them money with the expectation that they will get less of an inheritance because of the loan. If so, please explain.
Are any of your children handicapped, disabled, or otherwise in poor health? If yes, please explain.
Is there any reason to not treat your children equally? Please explain.
Do you have any special goals or concerns regarding your children?
If one of your beneficiaries were to pass away before you, who would you want their share to go to?
- That persons beneficiaries (i.e. their spouse and/or child); OR
- To other beneficiaries that you have listed.
Do you wish to be buried or cremated, or are you undecided?
If you wish to be cremated, do you have any requests for your remains?

Guardians
If your children are under the age of 18 (minors) when you die, and if their other parent is also not alive at that time, then the Court will appoint someone to be the legal guardian of your minor children. The guardian will have legal and physical custody of the children until they reach the age of 18. You can appoint someone to serve as the guardian for your minor children. Name a Guardian and a Successor Guardian (in case the primary guardian is unwilling or unable to serve).
Guardian Name
Address
Phone Number
Relationship
Successor Guardian Name
Address
Phone Number
Relationship

Personal Representative
Your personal representative (formerly called “executor”) is the person that administers your estate, winds up your financial affairs, pays your debts and taxes, and distributes the balance of your estate to the beneficiaries. A personal representative must be at least 18 years old. Name a Personal Representative and an Alternate Personal Representative (in case the primary personal representative is unable or unwilling to serve).
Personal Representative Name
Address
Phone Number
Relationship
Alternate Personal Representative Name
Address
Phone Number
Relationship

Trustee
If a trust is included in your estate plan, a “trustee” is the person or entity responsible for managing the assets placed in the trust for the benefit of the trust’s beneficiaries, i.e. your children. The trustee manages the assets according to the terms of the trust and distributes the assets according to the terms of the trust. You and/or your spouse will be the Trustees while you are alive. Once the last of you passes away, who do you want to appoint to be in control of the Trust, and to carry out those instructions contained in the Trust? Note that if you do not establish a trust, your children will inherit at age 18. The trustee can be an individual, bank, trust company, or a combination of these.
Trustee
Address
Phone Number
Relationship
Successor Trustee
Address
Phone Number
Relationship

Estate Planning Documents
Do you currently have any of the following documents?
Will: If yes, indicate the date
Durable Power of Attorney: If yes, indicate the date
Medical Power of Attorney: If yes, indicate the date
Living Will: If yes, indicate the date
Trust of Any Kind: If yes, indicate the date
If you would to have the documents reviewed, please bring them to our appointment.

Miscellaneous
Do you wish to disinherit someone?
If yes, provide name and relationship.

Note: You cannot fully disinherit your spouse. Spouses are entitled to a statutory minimum amount, unless the Spouse signs a Waiver of their right to do so.
Do you expect to receive any inheritance in the near future?
If yes, provide details.
Do you have a safe deposit box?
Where?
Does anyone else have access?
How many siblings do you have?
Any concerns?

Your Advisors:
Accountant's Name
Address
Phone Number
Financial Advisor
Address
Phone Number

Beneficiary Designations
Fill in the information for your assets that have a beneficiary designation, i.e. life insurance, retirement plans, joint bank accounts, etc. Due to the fact that these assets have beneficiary designations, they will pass outside your Will. This is important to know when building an estate plan.
Policy/Asset Face Value Owner Insured (if applicable) Beneficiary
Do you retirement accounts/plans have a death benefit?
If so, who is the named beneficiary?
Distribution
We will go over several different scenarios/contingencies during our meeting.
Do you wish to make any specific bequests to charities or individuals?

Health Care Directive
A health care directive is a useful tool in planning for incapacity and is a recommended part of any estate plan. A health care directive is a written document that makes known your health care wishes to family, friends, and doctors. It allows you to name a health care agent who will have the legal authority to make health care decisions for you – based on your wishes – if you become unable to communicate your health care wishes. It also allows you to specify your wishes in certain medical situations and your wishes for things such as funeral arrangements and organ donation.
Name of Agent
Address
Phone Number
Relationship
Name of Alternative Agent
Address
Phone Number
Relationship
Wishes regarding burial/cremation?
Wishes regarding organ donation?
Do you have an organ donation designation on your driver’s license?
Do you want directions as to what you want or do not want if you are in a terminal condition?
Do you have any previous health care directives?
Any other instructions?

Financial Power of Attorney
A power of attorney is a signed document giving another person (your agent) the legal authority to act on your behalf with respect to your assets. Powers of attorney can be narrowly tailored to specific powers or as broad as giving your agent the power to take all action related to your finances/assets that you would be able to do yourself. A power of attorney is recommended to be included in every estate plan as it is especially useful in planning for incapacity.
Name your agent: (“Attorney-in-Fact”)
Agent Name
Address
Phone Number
Relationship
Alternative Agent (in case the primary agent is unwilling or unable to serve)
Alternative Agent Name
Address
Phone Number
Relationship
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The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. We invite you to contact us and welcome your calls, letters and electronic mail. Click here for full disclaimer

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