Law Office of Sally Cooperrider

  210 N. 4th Street, Suite 101
San Jose, CA 95112
Phone: (408) 287-7717
Email: sally.cooperrider@sbcglobal.net

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) _____________________________________________________________________________