Estate Planning Intake Form

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Family Facts







































Marriage Information


YesNo

If Yes, please upload a copy of that agreement

YesNo

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

YesNo

If Yes, please select the states that you have lived

Wisconsin

Arizona

California

Texas

New Mexico

Washington

Louisiana

Nevada

Idaho

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



































































FINANCIAL FACTS

Estate Tax Exemption

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

Yes No

Financial Advisor(s)













Yes No

Yes No

Yes No

Yes No

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

Yes No

Yes No

Yes No

If yes, please upload a copy.

YesNo

DISTRIBUTION OF YOUR ESTATE




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.)



















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.)



















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



















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.)



















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



















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


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



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