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Joint Planning Intake Form
RainyCityDesigns2019
2020-04-08T09:36:22-07:00
JOINT 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.
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AVVO
Facebook
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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
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Physical Address (if different)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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/Life Partner info
Date of Marriage:
Place of Marriage
Spouse legal name to be used in documents:
*
Are you a US Citizen?
Yes
No
Previous marriage(s)?
*
Yes
No
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
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Name
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Name
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Name
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Do You Have More Children To Add?
*
Yes
No
Name
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Name
Age
Please enter a number from
0
to
99
.
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Do You Have More Children To Add?
*
Yes
No
Deceased Children
Name
M/F
M
F
Adopted
Yes
No
Parent
Joint
Husband
Wife
Name
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:
Goals and Concerns
Please provide your concern level – High or Low
Manage affairs upon death or disability
*
Self
High
Low
Manage affairs upon death or disability
*
Spouse
High
Low
Provide for and protect a spouse
*
High
Low
Self
Provide for and protect a spouse
*
High
Low
Spouse
Provide for and protect grandchildren
*
High
Low
Self
Provide for and protect grandchildren
*
High
Low
Spouse
Provide for a child with special needs or disabilities
*
High
Low
Self
Provide for a child with special needs or disabilities
*
High
Low
Spouse
Provide for charities at the time of death
*
High
Low
Self
Provide for charities at the time of death
*
High
Low
Spouse
Avoid or reduce estate taxes
*
High
Low
Self
Avoid or reduce estate taxes
*
High
Low
Spouse
Avoid probate
*
High
Low
Self
Avoid probate
*
High
Low
Spouse
Reduce administration costs at time of death
*
High
Low
Self
Reduce administration costs at time of death
*
High
Low
Spouse
Avoid a guardianship in case of a disability
*
High
Low
Self
Avoid a guardianship in case of a disability
*
High
Low
Spouse
Avoid will contests or other disputes upon death
*
High
Low
Self
Avoid will contests or other disputes upon death
*
High
Low
Spouse
Protect assets from lawsuits or creditors
*
High
Low
Self
Protect assets from lawsuits or creditors
*
High
Low
Spouse
Provide for the transfer and survival of a family business
*
High
Low
Self
Provide for the transfer and survival of a family business
*
High
Low
Spouse
Preserve the privacy of your affairs upon disability or death
*
High
Low
Self
Preserve the privacy of your affairs upon disability or death
*
High
Low
Spouse
Protect child’s inheritance from the possibility of failed marriages
*
High
Low
Self
Protect child’s inheritance from the possibility of failed marriages
*
High
Low
Spouse
Protect inheritance from a surviving spouse’s remarriage
*
High
Low
Self
Protect inheritance from a surviving spouse’s remarriage
*
High
Low
Spouse
Other:
Self
Other:
Spouse
Do you receive Social Security or other governmental benefits?
*
Yes
No
Please list below:
Are you paying pursuant to a marital dissolution or court order?
*
Yes
No
Please explain:
Have you signed a marriage contract? *
*
Yes
No
Please explain:
Have you signed a premarital or post marital agreement? *
*
Yes
No
Please explain:
Have you completed previous Will Trust, or Estate Planning? *
*
Yes
No
Please explain:
Are you the beneficiary of someone else’s estate or trust? *
*
Yes
No
Please explain:
Do any of your children receive governmental support or benefits? *
*
Yes
No
Please explain:
Do you own real estate interests in other states? *
*
Yes
No
Please explain:
Please add any additional other goals or concerns below.
[If yes, we may request copies of related documents]
Real Property
How you own real property is extremely important for purposes of properly designing and implementing your estate plan. For each property please indicate how the property is titled.
Residential Real Estate
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Do You Have Investment Real Estate?
*
Yes
No
Investment Real Estate
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Address
Titled
Individually owned
Jointly owned with spouse
Jointly owned with another
Owned by an entity such as an LLC or Trust
Unable to determine
Please list joint owners below:
Please explain:
Value
Loan
Do You Have Any Business Interests?
*
Yes
No
Business Interests
Name of Business
Type
% Owned
Value
Name of Business
Type
% Owned
Value
Name of Business
Type
% Owned
Value
Do You Have Any Art/Antiques/Jewelry or other you wish to include?
*
Yes
No
Art/Antiques/Jewelry or other
Description
Owner
Value
Loan
Do You Have Any Additional Art/Antiques/Jewelry You Wish To Include?
*
Yes
No
Please describe each item in the box below. Be sure to include a description, estimated value, and ownership.
Do You Have Any Personal Items Valued at $10,000 or more?
*
Yes
No
Personal items $10,000 or higher
Description
Owner
Value
Loan
Description
Owner
Value
Loan
Description
Owner
Value
Loan
Do You Have Any Additional Personal Items You Wish To Include?
*
Yes
No
Please describe each item in the box below. Be sure to include a description, estimated value, and ownership.
Do You Have Any Automobiles, Boats, RV’s, Motorcycles or Planes?
*
Yes
No
Automobiles, Boats, RV’s, Motorcycles & Planes
Description
Titled
Value
Loan
Description
Titled
Value
Loan
Description
Titled
Value
Loan
Do You Have Any Additional Vehicles/Boats/Planes/etc You Wish To Include?
*
Yes
No
Please describe each item in the box below. Be sure to include a description, estimated value, and ownership.
Bank & Savings Accounts
Name of Bank & Last 4 of account #
Type
Owner
Value
Name of Bank & Last 4 of account #
Type
Owner
Value
Name of Bank & Last 4 of account #
Type
Owner
Value
Do you have Retirement Accounts (IRA, 401K, 403B)?
*
Yes
No
Retirement Accounts (IRA, 401K, 403B)
Name of Plan & Last 4 of account #
Type
Owner
Value
Name of Plan & Last 4 of account #
Type
Owner
Value
Name of Plan & Last 4 of account #
Type
Owner
Value
Do you have other Investment Accounts (NON-retirement)?
*
Yes
No
Other Investment Accounts (NON-retirement)
Brokerage Firm & Last 4 of account #
Type
Owner
Value
Brokerage Firm & Last 4 of account #
Type
Owner
Value
Brokerage Firm & Last 4 of account #
Type
Owner
Value
Do you have Life Insurance Policies/Annuities?
*
Yes
No
Life Insurance Policies/Annuities
Insurance Company & Last 4 of account #
Type
Owner
Value
Insurance Company & Last 4 of account #
Type
Owner
Value
Insurance Company & Last 4 of account #
Type
Owner
Value
Are there any monies owed to you?
*
Yes
No
Monies Owed to You
Name of Debtor
Type
Due
Value
Name of Debtor
Type
Due
Value
Name of Debtor
Type
Due
Value
Do you expect any Anticipated Inheritance, Gifts or Lawsuit Judgment?
*
Yes
No
Anticipated Inheritance, Gifts or Lawsuit Judgment
Please describe the situation.
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 (sometimes called an Executor) and/or Trustee
The individual(s) who will manage, liquidate, and distribute your probate estate and if you have a trust The individual(s) who will manage and distribute your trust if you cannot serve or are deceased.
Client First Choice
*
Client Second Choice
Client Third Choice
Spouse First Choice
*
Spouse Second Choice
Spouse Third Choice
Durable Power of Attorney
The individual(s) authorized to make legal and financial decisions on your behalf if you cannot.
Client First Choice
*
Client Second Choice
Client Third Choice
Spouse First Choice
*
Spouse Second Choice
Spouse Third Choice
Healthcare Power of Attorney
The individual(s) authorized to make medical decisions should you become incapacitated
Client First Choice
*
Client Second Choice
Client Third Choice
Spouse First Choice
*
Spouse Second Choice
Spouse Third Choice
Living Will
*
Do you want a document to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Yes
No
Unsure, wish to discuss
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
Spouse 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?
Spouse - 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
Client Personal 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
To other named individuals
Please list individuals' names here:
Spouse Personal Property Distributions
*
Spouse, then to children equally
Children
To other named individuals
Please list individuals' names here:
Specific Gifts
List any specific gifts of real estate or cash gifts you wish to make to individuals or charities.
Client
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Spouse
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Individual or Charity
Amount or Property
Even If Spouse Survives?
Yes
No
Upon Death of First Spouse to Die
There are many alternatives for leaving property to or for the benefit of the surviving spouse, often determined by your goals and whether your estate might be subject to federal or state estate tax. Prior to meeting with the attorney, please consider what interest the surviving spouse will continue to have in the property of the first spouse to die if the surviving spouse remarries.
Client:
Will surviving spouse be the primary beneficiary upon death of first spouse?
Yes
No
If no, please explain:
Spouse:
Will surviving spouse be the primary beneficiary upon death of first spouse?
Yes
No
If no, please explain:
Remarriage Provisions
(for any part of your estate of trust held in trust for your spouse):
Remarriage does not affect the surviving spouse’s right to income or principal.
Remarriage terminates the surviving spouse’s right to distributions of income and principal, unless the spouse and the new spouse execute a valid prenuptial agreement protecting the rights of the spouse and descendants in case of divorce or death.
Upon Death of Second Spouse to Die
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)
Please explain:
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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