Law Offices of Robert Craig Wallach PA

12486 West Atlantic Avenue
Coral Springs, FL 33071

(954) 461-0015

Estate Planning Worksheet

Single Person

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.

This intake form collects information for a single person who intends to create an Estate Plan for themselves and does not collect information for a spouse or partner. If you are a relationship and are intending to create an estate plan for you and a partner such as your spouse, please contact our office for the intake form targeted for 2 clients.

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!

PART I - Personal Information

CLIENT INFORMATION

Contact information: Client 1

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 Used:

Also Known As:

(other names used to title property and accounts)

Prefer to Be Called:

Social Security #:

Are you currently employed?

Yes

Are either of your parents still living?

Yes

Are any of your grandparents still living?

Yes

Client's Marital History

Are you currently married?

Yes

Date of Marriage:

if applicable

Were you ever divorced?

Yes

Date of Divorce:

if applicable

Were you ever widowed?

Yes

Date that Former Spouse/Partner Died:

if applicable

CHILDREN AND OTHER FAMILY MEMBERS

Child or Other Family Member #1

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #2

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #3

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #4

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #5

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #6

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

Child or Other Family Member #7

If applicable, please fill out the following information.

Full Legal Name:

Date of Birth:

Relationship to You:

ex: Child, Sibling, Cousin, etc.

Additional Information:

Special Needs, Concerns, Adopted, etc.

YOUR CONCERNS

Please rate the following as to how important they are to you.

Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.

No Concern or Not Applicable

High Concern

Some Concern

Low Concern

Providing for and protecting children.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Providing for and protecting grandchildren.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Disinheriting a family member.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Providing for charities at the time of death.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Plan for the transfer and survival of a family business.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Avoiding probate.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Reduce administration costs at time of your death.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Avoiding a conservatorship (“living probate”) in case of a disability.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Avoiding will contests or other disputes upon death.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Protecting assets from lawsuits or creditors.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Plan for a child with disabilities or special needs, such as medical or learning disabilities.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Protecting children’s inheritance from the possibility of failed marriages.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Provide that your death shall not be unnecessarily prolonged by artificial means or measures.

High Concern

Some Concern

Low Concern

No Concern or Not Applicable

Other Concerns:

(Please list below)

IMPORTANT FAMILY QUESTIONS

(Please check “Yes” or “No” for your answer)

Are you receiving Social Security, disability, or other governmental benefits?

Yes

Are you making payments pursuant to a divorce or property settlement order?

Yes

Have either clients ever filed federal or state gift tax returns?

Yes

Have you completed previous will, trust, or estate planning?

Yes

Do you support any charitable organizations now that you wish to make provisions for at the time of your death?

Yes

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

Yes

Are you currently the beneficiary of anyone else’s trust?

Yes

Do any of your children have special educational, medical, or physical needs?

Yes

Do any of your children receive governmental support or benefits?

Yes

Do you provide primary or other major financial support to adult children or others?

Yes

Additional Information:

PART II - Property Information

Instructions for completing the Property Information checklist:

General Headings

This Property Information checklist helps you list all the property you own and what it is worth. If you do not own property under a particular heading, just leave that section blank.

Type

Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading.

“Owner” of Property

How you own your property is extremely important for purposes of properly designing and implementing your estate plan. For each property, please indicate how the property is titled. When doing so, please use the following abbreviations:

Client's Name alone, with no other person.

JTO

Joint Tenancy with someone else, i.e., a child, parent, etc.

If you cannot determine how the property is owned

Real Property

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

Real Property #1:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #2:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #3:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #4:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

Real Property #5:

if applicable, please select "Fill Out Real Property Information" and add the appropriate information

Fill Out Real Property Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Furniture and Personal Effects

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

Furniture or Other Personal Effects #1:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #2:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #3:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

Furniture or Other Personal Effects #4:

if applicable, please select "Fill Out Furniture or Other Personal Effects Information" and add the appropriate information

Fill Out Furniture or Other Personal Effects Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Automobiles, Boats, and RVs

TYPE: For each motor vehicle, boat, RV, etc. please list the following: description, how titled, market value and encumbrance:

Vehicle #1:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #2:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #3:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #4:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

Vehicle #5:

if applicable, please select "Fill Out Vehicle Information" and add the appropriate information

Fill Out Vehicle Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Bank Accounts

TYPE: Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s here

Bank Account #1:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #2:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #3:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #4:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

Bank Account #5:

if applicable, please select "Fill Out Bank Account Information" and add the appropriate information

Fill Out Bank Account Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Stocks and Bonds

TYPE: List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. (indicate type below)

Stock and/or Bond #1:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #2:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #3:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #4:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

Stock and/or Bond #5:

if applicable, please select "Fill Out Stock and/or Bond Information" and add the appropriate information

Fill Out Stock and/or Bond Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Life Insurance Policies and Annuities

TYPE: Term, whole life, split dollar, group life, annuity.

ADDITIONAL INFORMATION: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.

Life Insurance Policies and Annuities:

Total Value:

Retirement Plans

TYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K).

ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.

Retirement Plans:

Total Value:

Business Interests

TYPE: General and Limited Partnerships, Sole Proprietorships, privately-owned corporations, professional corporations, oil interests, farm, and ranch interests.

ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

Business Interests:

Total Value:

Money Owed To You

TYPE: 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 to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #2:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #3:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

Money Owed to You #4:

if applicable, please select "Fill Out Money Owed to You Information" and add the appropriate information

Fill Out Money Owed to You Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

Anticipated Inheritance, Gift, or Lawsuit Judgment

TYPE: 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. Describe in appropriate detail.

Anticipated Inheritance, Gift, or Lawsuit Judgment:

Total Estimated Value:

Other Assets

TYPE: 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 add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #2:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #3:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

Other Asset #4:

if applicable, please select "Fill Out Other Asset Information" and add the appropriate information

Fill Out Other Asset Information

Not Applicable

CLIENT - Total Value:

OTHER PERSON - Total Value:

if applicable

JOINT - Total Value:

* Joint Property values enter 1/2 in Client 1's space and 1/2 in Client 2's space.

PART III - Design Information

PERSONS TO ACT FOR YOU

Guardian for Minor Children

If you have any children under the age of 18, list in order of preference who you wish to be guardian.

Guardian for Minor Children #1:

if applicable, please select "Designate a Guardian for Minor Children" and add the appropriate information

Designate a Guardian for Minor Children

Not Applicable

Guardian for Minor Children #2:

if applicable, please select "Designate a Guardian for Minor Children" and add the appropriate information

Designate a Guardian for Minor Children

Not Applicable

Initial Trustees

Usually the Maker will be the Trustee of his or her own trust. Allows you to continue to jointly control your assets as before.

Initial Trustee #1:

if applicable, please select "Designate an Initial Trustee" and add the appropriate information

Designate an Initial Trustee

Not Applicable

Initial Trustee #2:

if applicable, please select "Designate an Initial Trustee" and add the appropriate information

Designate an Initial Trustee

Not Applicable

Disability Trustee

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your property and assets?

Disability Trustee #1:

if applicable, please select "Designate an Initial Trustee" and add the appropriate information

Designate an Initial Trustee

Not Applicable

Disability Trustee #2:

if applicable, please select "Designate an Initial Trustee" and add the appropriate information

Designate an Initial Trustee

Not Applicable

Disability Trustee #3:

if applicable, please select "Designate a Disability Trustee" and add the appropriate information

Designate a Disability Trustee

Not Applicable

Death Trustee

After your death, who do you want carrying out your instructions, for distribution to and, if desired, management of property for your beneficiaries?

Death Trustee #1:

if applicable, please select "Designate a Death Trustee" and add the appropriate information

Designate a Death Trustee

Not Applicable

Death Trustee #2:

if applicable, please select "Designate a Death Trustee" and add the appropriate information

Designate a Death Trustee

Not Applicable

Death Trustee #3:

if applicable, please select "Designate a Death Trustee" and add the appropriate information

Designate a Death Trustee

Not Applicable

Power of Attorney

If you were unable to make financial decisions for yourself, who would you want to make those decisions for you?

Agent #1:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #2:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #3:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated?

Yes

Living Will

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

Do you want to provide that your organs and tissues should be made available for transplant purposes?

Yes

Health Care

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?

Agent #1:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #2:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Agent #3:

if applicable, please select "Designate an Agent" and add the appropriate information

Designate an Agent

Not Applicable

Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home?

Yes

Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?

Yes

In making distributions during any period of time the client is incapacitated, the successor Trustee shall give primary consideration to:

Disabled client, the needs of others.

Disabled client and other use, and then needs of others

Disabled client needs and the needs of others equally.

DISTRIBUTIONS OF PERSONAL PROPERTY AND SPECIFIC GIFTS

Any property not listed on the memorandum should be distributed to:

Children

To the balance of the trust.

Other named individuals. List on next line.

SPECIFIC GIFTS

List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities. Indicate whether these gifts are to be made even if the other client is alive.

Specific Gift #1:

if applicable, please select "Bequest a Gift" and add the appropriate information

Bequest a Gift

Not Applicable

Specific Gift #2:

if applicable, please select "Bequest a Gift" and add the appropriate information

Bequest a Gift

Not Applicable

Specific Gift #3:

if applicable, please select "Bequest a Gift" and add the appropriate information

Bequest a Gift

Not Applicable

Specific Gift #4:

if applicable, please select "Bequest a Gift" and add the appropriate information

Bequest a Gift

Not Applicable

Specific Gift #5:

if applicable, please select "Bequest a Gift" and add the appropriate information

Bequest a Gift

Not Applicable

DESIGN OF MARITAL SHARE

• OUTRIGHT: We want to leave property outright to the surviving client. We recognize that this offers no
protection from creditors or predators. Allows surviving client to leave property to whomever surviving client wants.
Also allows a new spouse/partner to possibly make claim on property in case of death or divorce

• GENERAL APPOINTMENT TRUST: All income and principal are available to the surviving client upon
demand. The surviving client is free to do as he or she pleases. This would include the ability to remove all property in
the Marital Share from the trust.

• ALL INCOME – PRINCIPAL FOR NEEDS: All income is distributed to surviving client; principal is available
for his or her needs (health, education, maintenance, and support).

• ONLY INCOME: Only income is distributed to surviving client. Principal is not available to the surviving client.

DESIGN OF MARITAL SHARE:

OUTRIGHT

GENERAL APPOINTMENT TRUST

ALL INCOME – PRINCIPAL FOR NEEDS

ONLY INCOME

HOW AND WHEN TO DISTRIBUTE MY PROPERTY

• DISTRIBUTE OUTRIGHT TO OUR BENEFICIARIES: Provides no protection from creditors, predators, or from themselves.

• STRUCTURED TRUST: You determine how long the property is to remain in trust. During the period of time the property is held in trust it is available to the beneficiary for needs (health, education, maintenance, and support). You may give written instructions to the trustee outlining guidelines to follow in determining the beneficiary’s needs. You may provide for a staggered distribution of principal. For example:. 1/3 at age 30 and balance at age 40. You decide who will manage the property and to carry out your distribution instructions. Does the beneficiary have a right to be a co-trustee and/or choose his or her own co-trustee? You decide how the trust is designed. List your desires:

HOW AND WHEN TO DISTRIBUTE MY PROPERTY:

DISTRIBUTE OUTRIGHT TO MY BENEFICIARIES

STRUCTURED TRUST

OTHER ITEMS TO INCLUDE OR DISCUSS

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

General Documentation Request

In some instances, it is necessary for us to review other documents before we can make planning recommendations. If applicable, please bring the documents requested below with you to our first meeting:

1. Copies of all deeds to real estate owned by you.

2. Copies of the most recent financial statements evidencing your ownership of bank accounts, investment accounts, retirement accounts, and annuities.

3. Copies of any stock or bond certificates.
4. Do you have any Long-Term Care Policies? If yes, please bring a copy
5. Is there a Divorce Decree or Property Settlement Agreement for divorce under which continued obligations exist (child or spousal support, maintain life insurance policy, etc.)? If yes, please bring a copy
6. Last 3 years of personal income, corporate, or partnership tax returns.
7. Have you ever filed a gift tax, estate tax, or trust tax returns? If yes, please bring a copy.
8. Copies of any existing planning documents, including wills, trusts, powers of attorney, health care directives, etc.

Attach the above documents now?

Attach Documents Now

Attachment #1:

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Attachment #2:

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Attachment #3:

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Attachment #4:

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Attachment #5:

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Attachment #6:

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Attachment #7:

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THANK YOU

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