Single-Estate Planning Form

Intake Form

Date

DOCUMENTS REQUESTED:

Will

Power of Attorney

HC Proxy

HC Directive

(For Internal Use Only)

FILE NO.

Date Opened

Date Closed

Referred by

Type of Case: Estate Planning

YOUR NAME

DOB

HOME PHONE

CELL PHONE

ADDRESS

EMAIL ADDRESS

Free Text

BENEFICIARIES — CHILDREN AND/OR OTHERS

Name

Date of Birth

Address (if other than above

Name

Date of Birth

Address (if other than above

Name

Date of Birth

Address (if other than above

Free Text

SIBLINGS

Name

Address & telephone

Name

Address & telephone

Name

Address & telephone

Name

Address & telephone

Free Text

PARENTS

Name

Address & telephone

Name

Address & telephone

Name

Address & telephone

Free Text

EXECUTOR

Executor

Address & Tel

Alternate

Address & Tel

Free Text

POWER OF ATTORNEY

Agent

Address & Tel

Alternate

Address & Tel

Free Text

HEALTH CARE PROXY / LIVING WILL

Proxy

Address & Tel

Alternate

Address & Tel

Free Text

GUARDIAN FOR MINOR CHILDREN

Proxy

Address & Tel

Alternate

Address & Tel

Free Text

GUARDIAN FOR MINOR CHILDREN

Guardian

Address & Tel

Free Text

TRUSTEE(S)

Trustee(s)

Address & Tel

Free Text

ASSETS

Assets WITH beneficiary designations

Assets WITHOUT beneficiary designations

All Real Property (Real Estate) inside and outside of New Jersey:

Free Text

IF DIVORCED / WIDOWED

Date of Divorce or Death

Free Text

CHILDREN FROM PRIOR SPOUSE OR PERSON

List names and addresses of children

Free Text

SPECIAL INSTRUCTIONS

How would you like your Estate to be divided?

Single-Estate Planning Form

Intake Form

Contact our office to schedule an appointment today.

Cedar Knolls, NJ

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Garden City, NY

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