Law Office of Sally Cooperrider

Estate Planning Intake Form

Name _____________________________________________________________________

Spouse or Domestic Partner_____________________________________________________

Address_____________________________________________________________________

Other real property or accounts__________________________________________________

___________________________________________________________________________

___________________________________________________________________________

DOB (minors) or City (adult children)

Children ____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Person(s) that would distribute property after death (Trustee or Executor):

___________________________________Alt.______________________________________

Person(s) that would take care of minor children (if needed)

___________________________________ Alt.______________________________________

Person(s) that would manage finances of children

___________________________________Alt.___________________ ___________________

Plan for Distribution of Property:

Optional burial instructions (burial or cremation)______________________________________

Power of Attorney__________________________________Alt?_________________________

Address of Agent(s) _____________________________________________________________________________

Address of Agent(s) _____________________________________________________________________________

Address of Agent(s) _____________________________________________________________________________