Individual Planning Intake Form - Estate Planning Law Seattle

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Individual Planning Intake FormWookieWebBuilder202020-04-07T16:45:10-07:00

INDIVIDUAL ESTATE PLANNING WORKSHEET

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Thank you for considering our firm to assist with your Estate Planning needs. This worksheet is a tool we use to gather information important to developing an estate plan for you, customized to your specific priorities, goals and needs. Any information you convey is subject to attorney/client privilege and will be held in the strictest confidence. Returning the worksheet ahead of our meeting will allow us time to review your information; however, if you are unable to return it ahead of time, please bring it with you to your scheduled appointment. Your attorney will review the information with you, answer questions you may have and offer options suitable to your situation. Following the consultation, we most often have the information necessary to provide you a fee quote for the work we discuss, and fully draft your documents. Should you desire to review the documents ahead of signing, please let us know and we will make the necessary arrangements. It is our pleasure to be working with you. We may be reached by email at the following: johnk@kenneylawfirm.com info@kenneylawfirm.com
Please share with us how you heard about our firm.
Online
- AVVO
- Facebook
- Google
- John Kenney & Associates, PLLC Website
- Justia
- Other

Date*
Month
Day
Year
Client Information Legal Name to be used in documents
Name*
First Middle Last
Also Known As:
Mailing Address:*
Street Address Address Line 2 City State ZIP Code
Physical Address (if different)
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Fax
Email
Hidden
Are you a US Citizen?
- Yes
- No
Previous marriage(s)?*
- Yes
- No
Marital Status:*
- Married
- Single
- Life Partner
- Widowed
Spouse (or Partner) Full Name:
Family Information (please use additional pages if needed)
Living Children (Indicate if the child is (J) Joint, (H) Husband’s, or (W) Wife’s child)
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Deceased Children
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Name
Birthdate
Month
Day
Year
M/F
- M
- F
Adopted
- Yes
- No
Parent
- Joint
- Husband
- Wife
Other persons or charities you may want included in your estate planning
Do any of your children have special needs?
- Yes
- No
Please explain:
Are you now or do you anticipate becoming pregnant soon?
- Yes
- No
Are you now or do you anticipate adopting soon?
- Yes
- No
Are you aware of any children born outside your marriage?
- Yes
- No
Do you wish to specifically disinherit anyone?
- Yes
- No
If yes, please explain:
Please add any additional other relevant family information:
Advisors
Personal Attorney Name
Name
Phone
Email
Accountant Name
Name
Phone
Email
Financial Advisor Name
Name
Phone
Email
Insurance Agent Name
Name
Phone
Email
Are you satisfied with your current advisors or would you like a referral?
- Please Refer

Goals and Concerns
Please provide your concern level – High or Low
Manage affairs upon death or disability*
- High
- Low
Provide for and protect a spouse*
- High
- Low
Provide for and protect grandchildren*
- High
- Low
Provide for a child with special needs or disabilities*
- High
- Low
Provide for charities at the time of death*
- High
- Low
Avoid or reduce estate taxes*
- High
- Low
Avoid probate*
- High
- Low
Reduce administration costs at time of death*
- High
- Low
Avoid a guardianship in case of a disability*
- High
- Low
Avoid will contests or other disputes upon death*
- High
- Low
Protect assets from lawsuits or creditors*
- High
- Low
Provide for the transfer and survival of a family business*
- High
- Low
Preserve the privacy of your affairs upon disability or death*
- High
- Low
Protect child’s inheritance from the possibility of failed marriages*
- High
- Low
Protect inheritance from a surviving spouse’s remarriage*
- High
- Low
Other:
Do you receive Social Security or other governmental benefits? **
- Yes
- No
Are you paying pursuant to a marital dissolution or court order? **
- Yes
- No
Have you signed a marriage contract? **
- Yes
- No
Have you completed previous Will Trust, or Estate Planning? **
- Yes
- No
Are you the beneficiary of someone else’s estate or trust? **
- Yes
- No
Do any of your children receive governmental support or benefits? **
- Yes
- No
Do you own real estate interests in other states? **
- Yes
- No
[*If yes, we may request copies of related documents]

Other items to include or discuss:
Keeping in mind that you are a unique client with personal circumstances that are different than any of our other clients, we will strive to assist you in preparing a comprehensive estate plan that will address all of your hopes, fears, wishes and goals. To help us better serve you, please list any other items you want included, have questions about or otherwise wish to discuss.
Summary of Net Values
Asset Type & Net Value (= asset value, less any debts or mortgages)
Cash
Real Property
Business Interests
Tangible Property
Motor Vehicles
Banking Accounts
Retirement Accounts
Investment Accounts
Insurance/Annuities
Money Owed to you
Gifts/Inheritance
Monies Owed to you
Other
Total

Guardian(s) for Minor Children
If you have any children under the age of 18, who would you wish to be their guardian(s).
First Choice
Second Choice
Third Choice
Personal Representative(s)
The individual(s) who will manage, liquidate, and distribute your probate estate.
First Choice
Second Choice
Third Choice
Successor Trustee(s)
The individual(s) who will manage and distribute your trust if you cannot serve or are deceased.
First Choice
Second Choice
Third Choice
Durable Power of Attorney
The individual(s) authorized to make legal and financial decisions on your behalf if you cannot.
First Choice
Second Choice
Third Choice
Healthcare Power of Attorney
The individual(s) authorized to make medical decisions should you become incapacitated
First Choice
Second Choice
Third Choice
Living Will*
- Yes
- No
- Unsure, wish to discuss
Do you want a document to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Will your Medical Agent have authority to make anatomical gifts?*
- Yes
- No
If Yes,*
- For Transplant purposes only
- For Transplant and/or medical research purposes
Property Distributions*
We will provide you with a template to create a written memorandum on which you may make distributions of your personal property upon your death (This would include family heirlooms, antiques, furnishings and other personal items). Any property not listed on the Personal Memorandum should be distributed to:
- Spouse, then to children equally
- Children
- Spouse, then to the Trust
- To the Trust
- To other named individuals
Specific Gifts
List any specific gifts of real estate or cash gifts you wish to make to individuals or charities.
Individual or Charity
Amount or Property
Individual or Charity
Amount or Property
Individual or Charity
Amount or Property
Beneficiaries
- Children in equal shares (including descendants of deceased children)
- Children in some unequal division of shares (discuss with attorney)
- Other Persons or charities (list names and percentages and discuss with attorney)
How and When to Distribute Property
- Outright to my beneficiaries: Note: This option provides no protection from creditors, predators, lawsuits, judgments, bankruptcies, failed marriages and from themselves. The property is simply distributed to your beneficiaries with no further administration upon the death of the surviving spouse.
- Structured Trust: Please discuss the various options available to you with your attorney.
Remote Contingent Beneficiary
In the remote event that none of the beneficiaries listed above is alive to receive your property, how would you like your property distributed?
- To heirs at law
- One-half to Client’s heirs-at-law and one-half to Spouse’s heirs-at-law
- Divide among the following named individuals and/or charities
Please list here:

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