Estate Planning

Client Intake Form

Please complete this form before your consultation. Your answers help Jon prepare a plan tailored to your situation. All information is kept strictly confidential.

1 Complete this form

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2 Jon reviews your answers

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3 Meet for your consultation

Your Information

Full Name

Phone

Children

Full Name

Age

Full Name

Age

Full Name

Age

Full Name

Age

Full Name

Age

Full Name

Age

Living Immediate Relatives of You & Your Spouse

Parents, grandchildren, siblings, etc.

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Full Name

Relationship

Age

Assets

Business, Farm, or Ranch

Real Estate

Address

Market Value

Loan Amount

Other Assets (stocks, cash, car, etc.)

Testator's Wishes

To whom do you wish to give your tangible personal property (household items, tools, collectibles, autos, etc.)?

Do you have specific personal items you wish to leave to particular individuals?

Specific gifts of real estate or other intangible assets (stocks, CDs, etc.)?

Disposal of residual estate (remainder of estate not specifically given)?

Burial Preferences

Buried or Cremated?

Buried Cremated Undecided

Cemetery preferences or disposal of ashes preference?

Source of funds for burial/cremation?

Personal Representative

Primary Name

Relationship

Alternate Name

Relationship

Other

Do you provide care for an unmarried minor child, a disabled adult child, or a disabled spouse?

Yes No

If yes: Primary guardian/conservator

Alternate guardian/conservator

Are there any special needs of immediate family members because of health or disability?

Are you presently in a partnership, Investment Trust, or closely held corporation?

Yes No

Are you likely to inherit property?

Yes No

Have you created a trust, are you a beneficiary of a trust, or do you hold any powers of appointment?

Yes No

Please provide details for any "Yes" answers above