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Intake Form – Spouse or Partner

Intake Form – Spouse or Partnerrhapis2023-02-15T18:17:46+00:00
  • Confidential Estate Planning Intake Form & Personal and Confidential

  • To assist with creating your estate plan, please answer the following questions.

    Please note there are no right or wrong answers – only your answers:

    Identify any of the following issues that are important to you with an “X”

  • Family Information

  • Living Children (On the “Child of:” line indicate if child is(J)) Joint, (H) Husband’s, (W) Wife’s, or (P) Partner’s Child.)

  • Deceased Children (On the “Child of” line indicate if Child is (J) Joint, (H) Husband’s, (W) Wife’s, or (P) Partner’s Child.)

  • Family Information (Continued)

    Grandchildren

  • Client’s Parents

  • Client’s Siblings

  • Real Property

    Include your personal residence(s), investment property, vacation homes (excluding time shares), vacant land, mineral interests, etc. If you have a copy of your legal description or deed, please attach a copy to this form.
  • Bank Accounts and Investment Accounts

    Please do not list retirement account in this section such as: IRAs, 401Ks, Roth IRAs, SEPs, etc.
  • Retirements Accounts

    Please list your IRAs, 401Ks, SEPs, Profit Sharing, Thrift Savings, etc
  • Life Insurance Policies

  • Disability Insurance:

  • Information for Business Owners

  • Advisors

  • Trust Information

  • The Successor trustee takes over control of your trust after you or your original trustee can no longer serve as trustee. When your estate plan involves a revocable trust, you and/or Your Spouse/Partner usually serve as the initial Trustees. The Successor Trustee can be an individual, more than one individual, or a corporate entity (such as a bank or a trust company.)
  • Guardian for Minor Children (If Applicable)

    Please list the individual(s) who should be responsible for the care and control of your children in the event you are incapacitated or deceased.
  • Personal Representative

    Your Personal Representative will liquidate and administer your probate estate if necessary, your Personal Representative may be the same person or entity that you have named as your Successor Trustee
  • Durable Power of Attorney

    A Durable Power of Attorney is an individual who serves as an Attorney-in-Fact and is authorized to act on your behalf in a limited or general financial capacity. Your Attorney-in-Fact’s powers may be effective immediately or they may become effective only upon your incapacitation.
  • Healthcare Power of Attorney

    A Healthcare Power of Attorney is an individual you select as an agent to make decisions in regard to your medical care should you become incapacitated.
  • HIPAA Agent

    The individual(s) you appoint as your HIPAA Agent will immediately have full access to any and all of your medical records. Please list the individuals to be named as Authorized Recipients under the Health Insurance Portability and Accountability Act (HIPAA).
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