Georgia Lord Law

Phone: 404-888-3738

Confidential Intake Form for Wills and Estate Planning

Congratulations on your willingness to take the prudent step of executing a Will! We are happy to help you prepare and execute an estate plan that reflects your judgment and your values. Once this task is done you will enjoy greater peace of mind, secure in the knowledge that you have made prudent plans for those you love.

Please provide the information requested below. Don’t worry about total accuracy; just do the best you can. We look forward to seeing you!

  1. CONTACT INFORMATION

Your Complete Legal Name and Your Address:

Name: ______Date of Birth: ______

Address: ______

County of Residence: ______

Contact Information:

Home Number: ______

Do we have your permission to leave voice mail messages for you at this number? ____ Yes____ No

Work Number: ______

Do we have your permission to leave voice mail messages for you at this number? ____ Yes____ No

Cell Number: ______

Do we have your permission to leave voice mail messages for you at this number? ____ Yes____ No

E-Mail Address: ______

Do we have your permission to send confidential correspondence to this address? ____ Yes____ No

Preferred Method of Contact: ______

  1. BACKGROUND INFORMATION

Relationship Status: (circle the option that applies)

Single Married Domestic Partnership Divorced Widowed

The Complete Legal Name of Each Surviving Member of Your Immediate Family: Relationship DOB

(Please list any surviving spouse, domestic partner, child, parent, or sibling that you have)

______

______

______

______

______

______

______

______

______

Do you wish to leave some of your assets to one or more people not listed above? If so, please list them here:

Complete Legal Name DOB

______

______

______

______

______

Does your total estate, including retirement and insurance proceeds, exceed $5,000,000?

Yes ___ No ___

Do you have a Will, trust, or other estate planning document? Yes_____ No _____

(If you do, please provide a copy)

Are you making payments pursuant to a divorce, child support, or property settlement order?

Yes_____ No _____ (If you are, please furnish a copy of the applicable order and settlement documents)

If married, have you or your spouse signed either a Prenuptial or Postnuptial Agreement? Yes_____ No _____

(If such a contract has been signed, please furnish a copy)

Do you or any of your children or other beneficiaries have disabilities, serious health problems or other special needs? If yes, please describe below:

______

______

Do you own a business? Yes_____ No _____

III.CHOOSING YOUR BENEFICIARIES

At your death, to whom would you like your property to be distributed and in what proportions?

______

If the person (or people) you have named above does not survive you, to whom would you like your property distributed and in what proportions?

______

______

If your estate plan involves your children, and one of your children predeceases you, how would you wish for that child's share to be distributed?

A. His or her own children, if he or sheis survived by children

B. Divided among your surviving children

C. Other ______

Tangible Personal Property includes such items as furnishings, clothing, jewelry, china, silver, crystal, automobiles, boats, and memorabilia. You can include provisions in your Will gifting certain items to certain individuals. You can also include a paragraph in the Will explaining that youmay leave a memorandum with your personal papers that identifies certain items of tangible personal property to distribute at the time of your death to specified individuals. Using such a list (that is, one that is separate from your Will) makes it easy to adopt changes if you acquire additional items, dispose of listed items, or change your mind about some items.

Do you wish to make any specific designations regarding your Tangible Personal Property and, if so, what are they?

______

______

Do you support any charitable organizations now that you wish to make provisions for at the time of your death? If so, please identify such organization(s) and describe the type of provision you wish to make:

______

  1. CHOOSING THOSE WHO WILL CARRY OUT YOUR ESTATE PLAN

You will need to choose an Executor and may need to choose a Trustee and a Guardian. The Executor, Trustee, and Guardian can all be the same person or you may designate different persons for different tasks. You may also designate more than one person to act as Co-Executors, Co-Trustees, or Co-Guardians.

  1. EXECUTOR

An Executor is the person who is responsible for seeing that your estate is properly administered and the terms of your Will are carried out.

Whom do you select to serve as your Executor?

1st Choice- Full Name______Relationship______

Residence______

Telephone Number/Contact Information: ______

2nd Choice- Full Name______Relationship______

Residence______

Telephone Number/Contact Information: ______

  1. TRUSTEE

A Trustee is the person who manages any trust created by your Will, holding and managing the trust property. Wills often provide for trusts in order to manage the property and assets of persons who inherit while they are still young.

Whom do you select to serve as the Trustee, if one is needed?

1st Choice- Full Name______Relationship______

Residence______

Telephone Number/Contact Information: ______

2nd Choice- Full Name______Relationship______

Residence______

Telephone Number/Contact Information: ______

As to any trust created for minors, at what age of the beneficiary would you like such trust to end?

Age: ______

  1. GUARDIAN

A Guardian is the person who assumes the responsibility of physical custody of any minor children or incompetent adults who are in your care at the time of your death.

Do you currently have full or partial custody for any child or children? Yes ____ No ____

If you do, does the child/children have another living parent? Yes ____ No ____ N/A ____

Do you currently have full or partial responsibility for the care of an incompetent adult? Yes ____ No ____

Whom do you select to serve as the Guardian (if applicable)?

1st Choice- Full Name______

Residence______

Telephone Number/Contact Information: ______

2nd Choice- Full Name______

Residence______

Telephone Number/Contact Information: ______

  1. FINAL ARRANGEMENTS

Please list any specific instructions as to the disposition of your remains: e.g., cremation, donation for medical or scientific purposes, organ donation, placement at a specific cemetery, scattering of ashes in a particular manner, etc.:

______

______

Please provide any instructions or guidance you wish to give regarding your Memorial Service, Funeral, or other observance.

______

______

Current Assets:

For each type of asset listed below, please indicate whether you currently own any property of that type. Please, also, indicate in the “Notes” section such particulars as whether the listed asset is owned solely by you (or jointly with someone else) and whether you have already designated a beneficiary for the asset. (For example, if you have life insurance, who is the beneficiary designated under your policy?)

Type of Asset / Currently
Own / N/A / Notes: Jointly Held? Any Beneficiary
Designated? If so, who?
Primary Residence
Other Real Property
IRA (s)
401k
Checking Account (s)
Savings Account (s)
Money Market Account (s)
Stocks/Bonds/ Mutual Funds
Pension (s)
Deferred Compensation
Life Insurance
Annuity (s)
CD’s
Stock Options
Vehicle (s)
Business Interest
Valuable Tangible Personal Property
Inheritance Anticipated /Received
Other

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