Client Number 1Name* U.S. Citizen? Yes No Name Used to Sign Legal Documents Aliases or Other Names You Are Known By Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County of Residence Home PhoneCell PhoneBusiness PhoneEmail Social Security Number Age and Date of Birth Employer Occupation / Position Client Number 2Name U.S. Citizen? Yes No Name Used to Sign Legal Documents Aliases or Other Names Your are Known By Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County of Residence Home PhoneCell PhoneBusiness PhoneEmail Social Security Number Age and Date of Birth Employer Occupation / Position Date and Place of Marriage Child / Beneficiary Number 1Name Parent Client #1 Client #2 Joint Sex Male Female Date of Birth Month Day Year Special Needs? Medical Educational Financial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneSocial Security Number Spouse's Name (if married) Children's Full Names (Use married names if applicable. Please also note if biological, adopted, or step child)Child / Beneficiary Number 2Name Parent Client #1 Client #2 Joint Sex Male Female Date of Birth Month Day Year Special Needs? Medical Educational Financial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneSocial Security Number Spouse's Name (if married) Children's Full Names (Use married names if applicable. Please also note if biological, adopted, or step child)Child / Beneficiary Number 3Name Parent Client #1 Client #2 Joint Sex Male Female Date of Birth Month Day Year Special Needs? Medical Educational Financial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneSocial Security Number Spouse's Name (if married) Children's Full Names (Use married names if applicable. Please also note if biological, adopted, or step child)Child / Beneficiary Number 4Name Parent Client #1 Client #2 Joint Sex Male Female Date of Birth Month Day Year Special Needs? Medical Educational Financial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneSocial Security Number Spouse's Name (if married) Children's Full Names (Use married names if applicable. Please also note if biological, adopted, or step child)Child / Beneficiary Number 5Name Parent Client #1 Client #2 Joint Sex Male Female Date of Birth Month Day Year Special Needs? Medical Educational Financial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneSocial Security Number Spouse's Name (if married) Children's Full Names (Use married names if applicable. Please also note if biological, adopted, or step child)Guardians for Minor Children, If AnyWho do you wish to be the guardian of any of your children under the age of 18. Please list in the order of preference who you wish to be guardian.1st ChoiceName(s) Relationship Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell Phone2nd ChoiceName(s) Relationship Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell PhonePersonal RepresentativesThese matters will be discussed in more detail during your initial consult; however, you may want to give some advance consideration as to who you may name as personal representatives.1. TrustInitial Trustee(s): Typically, the trust maker is Trustee of his or her own trust. If married, both spouses may act jointly. Successor Trustee(s): If initial Trustee(s) are incapacitated or deceased, who do you wish to name as successor Trustee(s)?2. WillExecutor(s): An Executor is the person admitting the Will to probate and oversees assets subject to probate, if any. Typically, the Executor is the spouse. Successor Executor(s): If the Executor named above in unable or unwilling to serve, who do wish to name as successor Executor(s)? Typically, the successor Executor(s) are the same persons as the successor Trustee(s) should you have a trust created.3. General Durable Power of AttorneyIf you were unable to make financial decisions for yourself, who would you want to make such decisions for you? Typically, these persons are the same as your Trustee(s) and Executor(s). Client 1Client 24. Power of Attorney for Healthcare DecisionsIf you are unable to make decisions concerning your healthcare, who would you want to make such decisions and should they act individually or jointly with another?Client 1Client 2Beneficiary / Distribution Information1. List names of those who are to be primary beneficiaries of your estate.2. If your plan for distribution of assets is anything other than outright to children equally after your death or the death of both spouses, please explain what you wish to accomplish. We will discuss the pros and cons of leaving assets in trust as opposed to outright distribution.3. If your plan for distribution of assets is anything other than outright to children equally after your death or the death of both spouses, please explain what you wish to accomplish. We will discuss the pros and cons of leaving assets in trust as opposed to outright distribution.4. Do you wish to make any charitable gifts? Please indicate charity and amount or percentage to be donated. Please explain specific thoughts on use of funds.Other Special Thoughts or InstructionsDate MM slash DD slash YYYY
