estate planning intake form

CLIENT INFORMATION SHEET

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(For Internal Use Only)

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Type of Case: Estate Planning

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Date

WILL

HC PROXY

POWER OF ATTORNEY

HC DIRECTIVE

HUSBAND’S NAME:

DOB:

WIFE’S NAME:

DOB:

ADDRESS

PHONE NUMBER

HOME

CELL PHONE NUMBER

HUSB:

WIFE:

EMAIL ADDRESS

HUSB:

WIFE:

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BENEFICIARIES

CHILDREN:

DATE OF BIRTH

ADDRESS (if other than above)

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HUSBAND’S SIBLINGS:

Name(s):

Address & Telephone:

WIFE’S SIBLINGS:

Names(s):

Address & Telephone:

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PARENTS:

HUSBAND’S:

Names:

Address & telephone:

WIFE’S:

Names:

Address & telephone:

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EXECUTOR – For Wife

Name:

Address & telephone:

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ALTERNATE EXECUTOR

Name:

Address & telephone:

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EXECUTOR – For Husband

Name:

Address & telephone:

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ALTERNATE EXECUTOR

Name:

Address & telephone:

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POWER OF ATTORNEY:

For Wife

Name:

Address & telephone:

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ALTERNATE:

Name:

Address & telephone:

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POWER OF ATTORNEY:

For Husband

Name:

Address & telephone:

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ALTERNATE:

Name:

Address & telephone:

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HEALTH CARE

PROXY/LIVING WILL

For Wife

Name:

Address & telephone:

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ALTERNATE:

Name:

Address & telephone:

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HEALTH CARE

PROXY/LIVING WILL

For Husband

Name:

Address & telephone:

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ALTERNATE:

Name:

Address & telephone:

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GUARDIAN FOR MINOR

CHILDREN:

Name:

Address & telephone:

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TRUSTEE(S):

Name:

Address & telephone:

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List Assets With Beneficiary

Designations:

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List Assets Without Beneficiary

Designations:

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List of all Real Property (Real

Estate) inside and outside of

New Jersey:

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IF THIS IS A SECOND

MARRIAGE:

List Date of Divorce or Death:

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IF THERE ARE CHILDREN

FROM PRIOR SPOUSE OR

PERSON:

List names and address of Children:

SPECIAL INSTRUCTIONS – How would you like your Estate to be divided:

If you would rather fill out the PDF version of form and send it back to us, please click here to download

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You may submit your completed document HERE in our portal

https://go.thryv.com/site/JosephD.Sullivan/upload-document?action=kxvugqf2sktawff4

Fax: (973) 993-2821

Email: JDS@JosephSullivanESQ.com

Business Hours:

Monday - Friday: 9:00 A.M. – 5:00 P.M.

8 Ridgedale Ave

Cedar Knolls, NJ 07927

(973) 361-4099

1225 Franklin Ave

STE 325

Garden City, NY 11530

(516) 248-7777