Law Offices of Robert Craig Wallach PA

12486 West Atlantic Avenue
Coral Springs, FL 33071

(954) 461-0015

Estate Planning Worksheet

Thank you so much for contacting our law office. Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you.

CLIENT 1

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Pronouns:

Other Names:

Aliases

Social Security #:

Do you have a separate mailing address?

Yes

Immigration Status:

Are you currently employed?

Yes

Are you a veteran?

Yes

CLIENT 2

If there is an additional client, please fill out the following information. If not applicable, kindly skip to the next section.

Client 2's Full Legal Name:

Other Names:

Aliases

Pronouns:

Address:

If different from Client 1.

Phone:

Email:

Date of Birth:

Social Security #:

Client 2's Immigration Status:

Are you currently employed?

Yes

Are you a veteran?

Yes

RELATIONSHIP INFORMATION

(if applicable)

In respect of the relationship between CLIENT 1 and CLIENT 2, what is your relationship status?

Legally Married and Living Together

Legally Married but Separated

Not Legally Married but Living Together

Other

Date of Marriage:

(if applicable)

Place of Marriage:

CLIENT 1 - Do you have any previous marriages?

Yes

CLIENT 2 - Do you have any previous marriages?

Yes

Do you have a pre-marital agreement?

Yes

Previous Will

Do you have any previous will(s) or codicil(s)?

Yes

CHILDREN’S INFORMATION (if applicable)

Child #1

If applicable, please fill out the following information. If not applicable, kindly skip to the next section.

Child's Full Name:

Child's Full Address:

Child's Date of Birth:

Child's Email:

Child's Phone:

Spouse's or Partner's Name:

if applicable

Child's Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Child #2

If applicable, please fill out the following information. If not applicable, kindly skip to the next section.

Child's Full Name:

Child's Full Address:

Child's Date of Birth:

Child's Email:

Child's Phone:

Spouse's or Partner's Name:

if applicable

Child's Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Child #3

If applicable, please fill out the following information. If not applicable, kindly skip to the next section.

Child's Full Name:

Child's Full Address:

Child's Date of Birth:

Child's Email:

Child's Phone:

Spouse's or Partner's Name:

if applicable

Child's Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Child #4

If applicable, please fill out the following information. If not applicable, kindly skip to the next section.

Child's Full Name:

Child's Full Address:

Child's Date of Birth:

Child's Email:

Child's Phone:

Spouse's or Partner's Name:

if applicable

Child's Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Child #5

If applicable, please fill out the following information. If not applicable, kindly skip to the next section.

Child's Full Name:

Child's Full Address:

Child's Date of Birth:

Child's Email:

Child's Phone:

Spouse's or Partner's Name:

if applicable

Child's Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Do you have any additional children?

Yes

GRANDCHILDREN'S INFORMATION (if applicable)

Grandchild #1

Grandchild's Full Name:

Grandchild's Full Address:

Grandchild's Date of Birth:

Grandchild's Phone:

Grandchild's Email:

Name of Parents:

Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Grandchild #2

Grandchild's Full Name:

Grandchild's Full Address:

Grandchild's Date of Birth:

Grandchild's Phone:

Grandchild's Email:

Name of Parents:

Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Grandchild #3

Grandchild's Full Name:

Grandchild's Full Address:

Grandchild's Date of Birth:

Grandchild's Phone:

Grandchild's Email:

Name of Parents:

Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Grandchild #4

Grandchild's Full Name:

Grandchild's Full Address:

Grandchild's Date of Birth:

Grandchild's Phone:

Grandchild's Email:

Name of Parents:

Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Grandchild #5

Grandchild's Full Name:

Grandchild's Full Address:

Grandchild's Date of Birth:

Grandchild's Phone:

Grandchild's Email:

Name of Parents:

Additional Information:

(Adopted, From Another Marriage/Relationship, Special Needs, Specific Concerns)

Do you have any additional grandchildren?

Yes

DEPENDENTS OR OTHER BENEFICIARIES (if applicable)

Other Dependent or Beneficiary #1:

If applicable, please select "Fill Out Dependent or Beneficiary Information" and complete the following information.

Fill Out Dependent or Beneficiary Information

Full Name: Address: Age or Date of Birth: Phone: Email: Relationship to You: Additional Information:

Special Needs & Concerns

Not Applicable

Other Dependent or Beneficiary #2:

If applicable, please select "Fill Out Dependent or Beneficiary Information" and complete the following information.

Fill Out Dependent or Beneficiary Information

Full Name: Address: Age or Date of Birth: Phone: Email: Relationship to You: Additional Information:

Special Needs & Concerns

Not Applicable

Other Dependent or Beneficiary #3:

If applicable, please select "Fill Out Dependent or Beneficiary Information" and complete the following information.

Fill Out Dependent or Beneficiary Information

Full Name: Address: Age or Date of Birth: Phone: Email: Relationship to You: Additional Information:

Special Needs & Concerns

Not Applicable

Other Dependent or Beneficiary #4:

If applicable, please select "Fill Out Dependent or Beneficiary Information" and complete the following information.

Fill Out Dependent or Beneficiary Information

Full Name: Address: Age or Date of Birth: Phone: Email: Relationship to You: Additional Information:

Special Needs & Concerns

Not Applicable

Other Dependent or Beneficiary #5:

If applicable, please select "Fill Out Dependent or Beneficiary Information" and complete the following information.

Fill Out Dependent or Beneficiary Information

Full Name: Address: Age or Date of Birth: Phone: Email: Relationship to You: Additional Information:

Special Needs & Concerns

Not Applicable

Are there any other charitable organizations you wish to make provisions for at the time of your death?

ADVISORS

Attorney:

If applicable, please select "Fill Out Attorney Information" and complete the following information.

Fill Out Attorney Information

Not Applicable

Accountant:

If applicable, please select "Fill Out Accountant Information" and complete the following information.

Fill Out Accountant Information

Not Applicable

Financial Advisor:

If applicable, please select "Fill Out Financial Advisor Information" and complete the following information.

Fill Out Financial Advisor Information

Not Applicable

Life Insurance Agent:

If applicable, please select "Fill Out Life Insurance Agent Information" and complete the following information.

Fill Out Life Insurance Agent Information

Not Applicable

Long-Term Care Insurance Agent:

If applicable, please select "Fill Out Long-Term Care Insurance Agent Information" and complete the following information.

Fill Out Long-Term Care Insurance Agent Information

Not Applicable

Other Advisor #1:

If applicable, please select "Fill Out Advisor Information" and complete the following information.

Fill Out Other Advisor Information

Not Applicable

Other Advisor #2:

If applicable, please select "Fill Out Advisor Information" and complete the following information.

Fill Out Other Advisor Information

Not Applicable

ASSETS

For each asset, please select “Yes” and fill out the following information.

Real Property

Any interest in real estate including your family residence, vacation home, timeshare, or vacant land.

Real Property #1:

If applicable, please select "Fill Out Real Property Information" and complete the following information.

Fill Out Real Property Information

Not Applicable

Real Property #2:

If applicable, please select "Fill Out Real Property Information" and complete the following information.

Fill Out Real Property Information

Not Applicable

Real Property #3:

If applicable, please select "Fill Out Real Property Information" and complete the following information.

Fill Out Real Property Information

Not Applicable

Real Property #4:

If applicable, please select "Fill Out Real Property Information" and complete the following information.

Fill Out Real Property Information

Not Applicable

Furniture and Personal Effects

List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (give lump sum value for miscellaneous less separately listed valuable items).

Furniture or Personal Effect #1:

If applicable, please select "Fill Out Furniture or Personal Effect Information" and complete the following information.

Fill Out Furniture or Personal Effect Information

Not Applicable

Furniture or Personal Effect #2:

If applicable, please select "Fill Out Furniture or Personal Effect Information" and complete the following information.

Fill Out Furniture or Personal Effect Information

Not Applicable

Furniture or Personal Effect #3:

If applicable, please select "Fill Out Furniture or Personal Effect Information" and complete the following information.

Fill Out Furniture or Personal Effect Information

Not Applicable

Furniture or Personal Effect #4:

If applicable, please select "Fill Out Furniture or Personal Effect Information" and complete the following information.

Fill Out Furniture or Personal Effect Information

Not Applicable

Automobiles, Boats and RVs

For each motor vehicle, boat, RV, etc.

Vehicle Information #1:

If applicable, please select "Fill Out Vehicle Information" and complete the following information.

Fill Out Vehicle Information

Not Applicable

Vehicle Information #2:

If applicable, please select "Fill Out Vehicle Information" and complete the following information.

Fill Out Vehicle Information

Not Applicable

Vehicle Information #3:

If applicable, please select "Fill Out Vehicle Information" and complete the following information.

Fill Out Vehicle Information

Not Applicable

Vehicle Information #4:

If applicable, please select "Fill Out Vehicle Information" and complete the following information.

Fill Out Vehicle Information

Not Applicable

Bank & Savings Accounts

Bank Account #1:

If applicable, please select "Fill Out Bank Account Information" and complete the following information.

Fill Out Bank Account Information

Not Applicable

Bank Account #2:

If applicable, please select "Fill Out Bank Account Information" and complete the following information.

Fill Out Bank Account Information

Not Applicable

Bank Account #3:

If applicable, please select "Fill Out Bank Account Information" and complete the following information.

Fill Out Bank Account Information

Not Applicable

Bank Account #4:

If applicable, please select "Fill Out Bank Account Information" and complete the following information.

Fill Out Bank Account Information

Not Applicable

Investment Accounts, Bonds, Stocks and Stock Options

List any and all investment accounts (IA), bonds (B), stocks (S) and stock options (SO) you have an interest in. If including stock options, please indicate the value of vested and unvested options separately. If held in a brokerage account, lump them together under each account.

Investment Account, Bond, Stock or Stock Option #1:

If applicable, please select "Fill Out Investment Account, Bond, Stock or Stock Option Information" and complete the following information.

Fill Out Investment Account, Bond, Stock or Stock Option Information

Not Applicable

Investment Account, Bond, Stock or Stock Option #2:

If applicable, please select "Fill Out Investment Account, Bond, Stock or Stock Option Information" and complete the following information.

Fill Out Investment Account, Bond, Stock or Stock Option Information

Not Applicable

Investment Account, Bond, Stock or Stock Option #3:

If applicable, please select "Fill Out Investment Account, Bond, Stock or Stock Option Information" and complete the following information.

Fill Out Investment Account, Bond, Stock or Stock Option Information

Not Applicable

Investment Account, Bond, Stock or Stock Option #4:

If applicable, please select "Fill Out Investment Account, Bond, Stock or Stock Option Information" and complete the following information.

Fill Out Investment Account, Bond, Stock or Stock Option Information

Not Applicable

Life Insurance Policies and Annuities

Types: Term, Whole Life, Split Dollar, Group Life, Annuity.

Policy #1:

If applicable, please select "Fill Out Policy Information" and complete the following information.

Fill Out Policy Information

Name of Company: Type of Account: Face Amount:

(death benefit)

Whose Life is Insured: Who Owns the Policy: The Current Beneficiaries: Who Pays the Premium: Who Is The Life Insurance Agent:

Not Applicable

Policy #2:

If applicable, please select "Fill Out Policy Information" and complete the following information.

Fill Out Policy Information

Name of Company: Type of Account: Face Amount:

(death benefit)

Whose Life is Insured: Who Owns the Policy: The Current Beneficiaries: Who Pays the Premium: Who Is The Life Insurance Agent:

Not Applicable

Policy #3:

If applicable, please select "Fill Out Policy Information" and complete the following information.

Fill Out Policy Information

Name of Company: Type of Account: Face Amount:

(death benefit)

Whose Life is Insured: Who Owns the Policy: The Current Beneficiaries: Who Pays the Premium: Who Is The Life Insurance Agent:

Not Applicable

Policy #4:

If applicable, please select "Fill Out Policy Information" and complete the following information.

Fill Out Policy Information

Name of Company: Type of Account: Face Amount:

(death benefit)

Whose Life is Insured: Who Owns the Policy: The Current Beneficiaries: Who Pays the Premium: Who Is The Life Insurance Agent:

Not Applicable

Retirement Plans

Pension, Profit Sharing, H.R.10, IRA, SEP, 401K

Retirement Plan #1:

If applicable, please select "Fill Out Retirement Plan Information" and complete the following information.

Fill Out Retirement Plan Information

Not Applicable

Retirement Plan #2:

If applicable, please select "Fill Out Retirement Plan Information" and complete the following information.

Fill Out Retirement Plan Information

Not Applicable

Retirement Plan #3:

If applicable, please select "Fill Out Retirement Plan Information" and complete the following information.

Fill Out Retirement Plan Information

Not Applicable

Retirement Plan #4:

If applicable, please select "Fill Out Retirement Plan Information" and complete the following information.

Fill Out Retirement Plan Information

Not Applicable

Business Interests

General and Limited Partnerships, Sole Proprietorships, Privately Owned Corporations, Oil Interests, Farm and Ranch Interests

Business Interest #1:

If applicable, please select "Fill Out Business Information" and complete the following information.

Fill Out Business Information

Not Applicable

Business Interest #2:

If applicable, please select "Fill Out Business Information" and complete the following information.

Fill Out Business Information

Not Applicable

Business Interest #3:

If applicable, please select "Fill Out Business Information" and complete the following information.

Fill Out Business Information

Not Applicable

Business Interest #4:

If applicable, please select "Fill Out Business Information" and complete the following information.

Fill Out Business Information

Not Applicable

Money Owed to You

Mortgages or promissory notes payable to you, or other moneys owed to you.

Money Owed to You #1:

If applicable, please select "Fill Out Money Owed toYou Information" and complete the following information.

Fill Out Money Owed toYou Information

Not Applicable

Money Owed to You #2:

If applicable, please select "Fill Out Money Owed toYou Information" and complete the following information.

Fill Out Money Owed toYou Information

Not Applicable

Money Owed to You #3:

If applicable, please select "Fill Out Money Owed toYou Information" and complete the following information.

Fill Out Money Owed toYou Information

Not Applicable

Money Owed to You #4:

If applicable, please select "Fill Out Money Owed toYou Information" and complete the following information.

Fill Out Money Owed toYou Information

Not Applicable

Anticipated Inheritance, Gift, or Lawsuit Judgment

Gifts or Inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit.

Anticipated Inheritance, Gift, or Lawsuit Judgment:

Describe in appropriate detail.

Safe Deposit Box

Safe Deposit Box Details:

(Name of Bank, Value, Etc.)

Other Assets

Other property is any property that you have that does not fit into any listed category.

Other Asset #1:

If applicable, please select "Fill Out Other Asset Information" and complete the following information.

Fill Out Other Asset Information

Not Applicable

Other Asset #2:

If applicable, please select "Fill Out Other Asset Information" and complete the following information.

Fill Out Other Asset Information

Not Applicable

Other Asset #3:

If applicable, please select "Fill Out Other Asset Information" and complete the following information.

Fill Out Other Asset Information

Not Applicable

Other Asset #4:

If applicable, please select "Fill Out Other Asset Information" and complete the following information.

Fill Out Other Asset Information

Not Applicable

LIABILITIES

Mortgages, Loans Credit Cards or Other Liabilities

Liability #1:

If applicable, please select "Fill Out Liability Information" and complete the following information.

Fill Out Liability Information

Not Applicable

Liability #2:

If applicable, please select "Fill Out Liability Information" and complete the following information.

Fill Out Liability Information

Not Applicable

Liability #3:

If applicable, please select "Fill Out Liability Information" and complete the following information.

Fill Out Liability Information

Not Applicable

Liability #4:

If applicable, please select "Fill Out Liability Information" and complete the following information.

Fill Out Liability Information

Not Applicable

Liability #5:

If applicable, please select "Fill Out Liability Information" and complete the following information.

Fill Out Liability Information

Not Applicable

NOMINATION OF POWERS

Identify all potential Trustees, Executors, Financial Agents, Health Care Agents, Long-Term Guardians, Short-Term Guardians, and Guardians for Pets

Executors

Upon your death, who do you want to manage and distribute the assets you leave in your estate?

CLIENT 1 - Would you like to list your EXECUTORS?

Yes

CLIENT 2 - Would you like to list your EXECUTORS?

Yes

Trustees

Upon your death, who do you want to manage and distribute the assets you leave in your trust estate for children?

CLIENT 1 - Would you like to list your TRUSTEES?

Yes

CLIENT 2 - Would you like to list your TRUSTEES?

Yes

Guardians of Minor Children

If you have children under the age of 18, list those persons who you would wish to raise and love them in the manner closest to the way you would.

CLIENT 1 - Would you like to list your GUARDIANS OF MINOR CHILDREN?

Yes

CLIENT 2 - Would you like to list your GUARDIANS OF MINOR CHILDREN?

Yes

Durable Power of Attorney

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your financial affairs?

CLIENT 1 - Would you like to list your DURABLE POWER OF ATTORNEY AGENTS?

Yes

CLIENT 2 - Would you like to list your DURABLE POWER OF ATTORNEY AGENTS?

Yes

Health Care Power of Attorney

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your health care?

CLIENT 1 - Would you like to list your HEALTH CARE AGENTS?

Yes

CLIENT 2 - Would you like to list your HEALTH CARE AGENTS?

Yes

ADDITIONAL INFORMATION

Additional Information or Concerns:

Your estate plan should address all your hopes, fears, and wishes. Please list any other items you want included or want to discuss.

Who Referred You To Us?

THANK YOU

When you are finished, please click the "Submit" button.