Estate Planning Intake Form - Minnesota Construction Law Services

Client Name

Family Facts

Name:

Home Address:

City, State, Zip:

Country:

Home Phone:

Cell:

SSN:

Date of Birth:

Citizenship:

Annual Income:

Spouse/Partner Name:

Home Address:

City, State, Zip:

Country:

Home Phone:

Cell:

SSN:

Date of Birth:

Citizenship:

Annual Income:

Marriage Information

Date of Marriage:

Have you and your spouse signed a premarital agreement? YesNo

If Yes, please upload a copy of that agreement

Have you or your spouse been divorced? YesNo

If Yes, please upload a copy of the divorce decree(s).

Have you ever lived in a community Property State? YesNo

If Yes, please select the states that you have lived

Children

Please list ALL children, including deceased children and children born out of wedlock.

Please identify any child who is not a natural or adopted child of both you and your spouse

Name of child:

Address:

City, State, Zip:

Phone No.(s):

Date of Birth:

Name of child:

Address:

City, State, Zip:

Phone No.(s):

Date of Birth:

Name of child:

Address:

City, State, Zip:

Phone No.(s):

Date of Birth:

FINANCIAL FACTS

Estate Tax Exemption

Federal Exemption - $11.8 Million
Minnesota Exemption - $3.0 Million
Wisconsin Exemption – Does not have an estate tax

Do you think your estate is large enough that we need to consider estate taxes? Yes No

Financial Advisor(s)

Name

Company

Address

City,St, Zip

Phone

Fax

Name

Company

Address

City,St, Zip

Phone

Fax

Do either of you expect an inheritance in the future? If yes, please explain below.Yes No

Will any member of your immediate family require special treatment (e.g., someone with physical or mental disabilities)? If yes, please explain below.Yes No

Will anyone, other than small children be dependent on you in the future?If yes, please explain below. Yes No

Have you or someone acting on your behalf created any trusts? Yes No

If yes, please upload a copy of the trust agreement(s) with a schedule of assets.

Are you, your spouse, and/or any of your children currently a beneficiary of a trust? If yes, please explain below. Yes No

Have you and/or your spouse individually made any gifts over $15,000 in any one year to one individual? If yes, please enter how much below.Yes No

Have Gift Tax Returns ever been filed? Yes No

If yes, please upload a copy.

Do you or your spouse own any interest in a business whose stock is not publicly traded (e.g., small corporations, partnerships, LLC’s, Investment Groups, etc.)? If yes, please explain below.YesNo

DISTRIBUTION OF YOUR ESTATE

Would you like to distribute your estate in equal shares to your children?

Would you like to make any charitable requests, such as to a specific charity? If yes, please provide full Name, address of organization, and amount of gift:

Do you wish to make a specific gift to an individual? If yes, please provide full name, address, relationship toyou and amount or description of gift:

REPRESENTATION & INSTRUCTIONS

Guardians. Who should be guardian of your minor children? (A guardian has physical and legal control overyour children until they reach the age of 18.) (The spouse is typically listed first.)

Guardian

Relationship to you:

Address:

City, State, Zip:

Phone:

Alternate:

Relationship to you:

Address:

City, State, Zip:

Phone:

Personal Representative. Who should be Personal Representative (“executor”) of your estate? A Personal Representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate. (The spouse is typically listed first.)

Personal Rep:

Relationship to you:

Address:

City, State, Zip:

Phone:

Alternate:

Relationship to you:

Address:

City, State, Zip:

Phone:

Trusts. If a trust is appropriate to include in your estate plan, who should be the trustee? A trustee is the person, bank, or trust company who is responsible for managing the assets you place in your trust. A trustee also manages the assets for your children or other beneficiaries until they reach 18 years old or whatever ages you choose to specify

Trustee

Relationship to you:

Address:

City, State, Zip:

Phone:

Alternate

Relationship to you:

Address:

City, State, Zip:

Phone:

Financial Representation. Who will represent you in financial matters if you become incapacitated or otherwise unable to handle your finances? (The spouse is typically listed first.)

Attorney-in-fact:

Relationship to you:

Address:

City, State, Zip:

Phone:

Alternate

Relationship to you:

Address:

City, State, Zip:

Phone:

Health Care Representation. Who will represent you in medical decisions if you are unable to communicate your wishes? (The spouse is typically listed first.)

Agent:

Relationship to you:

Address:

City, State, Zip:

Phone:

Alternate

Relationship to you:

Address:

City, State, Zip:

Phone:

Health Care Preferences. Do you agree or disagree with the following statement?

“If I am in a terminal condition and cannot express my wishes, I wish to be allowed to die naturally and not be kept alive by artificial means or heroic measures. I do not want any medical treatment that will not substantially improve my condition or help me recover but will only postpone the moment of my death. However, I want whatever care is appropriate to keep me as comfortable and as free of pain as is reasonably possible, including the administration of pain relieving drugs and surgical or medical procedures calculated to relieve my pain, even though some drugs or procedures may hasten my death.”

Agree; I do not want prolonged life support.

Disagree; I prefer to be kept alive by artificial means

What are your preferences for prolonged health care?

Organ Donorship:

I wish to donate my organs, tissue and other body parts when I die.

I do not wish to donate

I wish to be buried; OR

I wish to be cremated.

Other, Explain below

Other Notes Regarding Health Care Preferences:

OTHER NOTES, COMMENTS, PREFERENCES, NEEDS

NOTE: If you need more space on an area of this form, please contact Shelley@shelley@mncls.com