Intake

Section 1: Personal Information

Full Legal Name:

Other Names (e.g., maiden, previous legal names):

Date of Birth:

Gender:

Social Security Number (last four digits):

Home Address:

City, State, ZIP:

Mailing Address (if different):

Phone Numbers:

Home:

Mobile:

Work:

Email Address

Marital StatusSingleMarriedDomestic PartnershipWidowedDivorced

Spouse/Partner's Information (if applicable):

Full Legal Name:

Gender:

Date of Birth:

Social Security Number (Last four digits):

Email Address:

Do you or your spouse/partner have any prior marriages?YesNo

If yes, please provide details (eg., names of ex-spouses, dates of marriage/divorce, obligations such as alimony):

Section 2: Children and Dependents

Loans to Beneficiaries

Have you loaned money to any beneficairy during your lifetime that you wish to have subtracted from their inheritance?YesNo

If yes, please provide details of the loan(s), including the amount, date, and name of the beneficiary:

Beneficiary Name:

Amount Loaned

Date of Loan

Additional Details

General Information

List of Children (include biological, adopted, and stepchildren):

Child 1 Name:

Date of Birth:

Last 4 SSN:

Address

Email:

Phone:

Child 2 Name:

Date of Birth:

Last 4 SSN:

Address

Email:

Phone:

Child 3 Name:

Date of Birth:

Last 4 SSN:

Address

Email:

Phone:

Are any children minors (under 18)? YesNo

Are any children disabled or require special needs planning?YesNo

If yes, please explain

Do you have any other depentents (eg., elderly parents, other relatives)?YesNo

If yes, please provide details:

Children and Dependents with Special Concerns

If any child or beneficiary has unique circumstances (e.g., substance abuse, financial irresponsibility, health issues, or disability), please provide detailed information so we can structure the estate plan appropriately.

Name of Child/Beneficiary:

Date of Birth:

Last 4 SSN:

Address

Email:

Phone:

Specific Concern (eg., drug/alcohol dependency, creditor risks, disability):

Suggested Approach (e.g., structured trust distributions, special needs trust, financial oversight by a trustee):

Name of Child/Beneficiary:

Date of Birth:

Last 4 SSN:

Address

Email:

Phone:

Specific Concern (eg., drug/alcohol dependency, creditor risks, disability):

Suggested Approach (e.g., structured trust distributions, special needs trust, financial oversight by a trustee):

Additional Notes for Special Circumstances

Section 3: Burial and Funeral Wishes

Do you have specific burial or funeral instructions?BurialCremationNo preference

Location of burial/cremation (if applicable):

Other specific instructions (e.g., religious ceremonies, scattering ashes):

Do you have a prepaid funeral plan?YesNo

If yes, provide details (e.g., location, plan details):

Section 4: Assets

Real Property and Single-Person Trusts

If you are a single individual with a trust that owns real property, do you wish for your partner to have a legal right to continue living in the residence if you pass away first?YesNo

If yes, please provide details about the property and the specific terms you wish to include:

Property Address:

Partner's Name

Additional Details or Conditions:

General Assets

Real Property (e.g., homes, land, rental properties):

Address:

Approx. Value:

Address:

Approx. Value

Bank Accounts (Checkings, Savings, CDs):

Institution:

Type:

Balance:

Institution:

Type:

Balance:

Investment Accounts (Brokerage, Stocks, Bonds):

Institution:

Account #:

Value:

Institution:

Account #:

Value:

Retirement Accounts (IRA, 401(k), Pension):

Institution:

Type:

Value:

Institution:

Type:

Value:

Cryptocurrency (e.g., Bitcoin, Ethereum):

Platform/Wallet Name:

Balance:

Life Insurance Policies:

Company:

Policy #:

Value:

Beneficiary:

Annuities:

Provider:

Value:

Beneficiary:

Business Interests (LLCs, Corporations, Partnerships):

Name of Business:

Value:

% Ownership:

Other Assets (e.g., vehicles, boats, art, jewelry):

Descriptions:

Value:

Descriptions:

Value:

Digital Assets

Do you have any online accounts, digital files, or cryptocurrencies that require specific handling after your death?YesNo

If yes, please provide access information and instructions for handling these assets.

Pets

Do you have any pets you want to provide for after your passing?YesNo

If yes, please specify the pet(s), caregiver(s), and funds to be allocated for their care.

Heirlooms or Sentimental Items:

Are there specific family heirlooms, collections, or sentimental items you want distributed to particular individuals?YesNo

If yes, please describe the items and the intended receipts.

Section 5: Debts and Liabilities

Mortgages

Lender:

Balance:

Monthly Payment:

Address of Property:

Loans (e.g., Personal, student):

Lender:

Balance:

Monthly Payment:

Purpose (e.g., student, personal):

Credit Card Balances

Institution:

Balance:

Interest Rate:

Other Debts

Description:

Gifts Made During Lifetime:

Have you made any significant financial gifts during your lifetime (above annual gift tax exclusion)?YesNo

If yes, please provide details:

Section 6: Estate Planning Goals

Primary Goals (check all that apply)

Special Concerns (e.g., blended family, specific beneficiaries, unique circumstances):

Section 6A: Distribution of Assets at Death

Intentional Disinheritance:

Are there any individuals you wish to intentionally disinherit from your estate?YesNo

If yes, please provide the following information for each individual:

Name:

Relationship:

Reason (optional):

Specific Cash Bequests:

Do you wish to leave specific cash dollar amounts to individuals or organizations?YesNo

if yes, please specify:

Name of Recipient:

Amount:

Are there conditions under which this gift should lapse (e.g., if the estate is below a certain value)?YesNo

If yes, please describe

Percentage Distribution of Estate

Do you wish to distribute your estate by percentages to beneficiaries?YesNo

If yes, please specify:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Beneficiary Name:

Percentage:

Residual Estate:

How should the remaining balance of your estate (after specific gifts and expenses) be distributed?Equally among beneficiariesOther

If other, please specify:

Contingent Beneficiaries

If primary beneficiaries do not survive you, who should receive their share?

Name:

Relationship:

Section 7: Fiduciaries

Guardian and Conservator for Yourself (if needed):

Preferred Guardian:

Name:

Relationship:

Address

Phone

Email:

Alternate Guardian:

Name:

Relationship:

Address

Phone

Email:

Preferred Conservator:

Name:

Relationship:

Address

Phone

Email:

Alternate Conservator:

Name:

Relationship:

Address

Phone

Email:

Personal Representative (Executor)

Name:

Relationship:

Address

Phone

Email:

Trustee (if creating a trust):

Name:

Relationship:

Address

Phone

Email:

Trustee (if creating a trust):

Name:

Relationship:

Address

Phone

Email:

Trustee (if creating a trust):

Name:

Relationship:

Address

Phone

Email:

Guardian for Minor Children:

Name:

Relationship:

Address

Phone

Email:

Health Care Representative

Name:

Relationship:

Address

Phone

Email:

Power of Attorney:

Name:

Relationship:

Address

Phone

Email:

Section 8: Miscellaneous

Charitable Giving

Do you wish to leave any part of your estate to a charity or nonprofit organization?YesNo

If yes, please provide the organization's name and intended amount or asset:

Business Ownership:

Do you own or have an interest in any businesses?YesNo

If yes, do you have a succession plan in place?YesNo

Safe Deposit Box:

Do you have a safe deposit box?YesNo

If yes, where is it located, and who has access?

Location of Important Documents:

Where will you keep your estate planning documents (e.g., will, trust, power of attorney)?

Legacy Planning:

Would you like to include a letter to your loved ones expressing your values, wishes, or final messages?YesNo

Conflict Resolution

Are there any anticipated disputes among heirs or beneficiaries?YesNo

If yes, would you like to include language in your estate plan to mitigate conflict (e.g., no-contest clauses)?YesNo

Final Section: Additional Information

Use the space below to provide any additional details or notes regarding your estate plan.

OCTOBER ONLY: Specific deal details and big number 50%

Comprehensive Estate Planning Questionnaire

Scott Bucy, Attorney at Law
osb # 181944
‍
541.631.9100
Jessica@ashlandoregonlaw.com

PO Box 718
Ashland, Oregon 97520

OCTOBER ONLY: Specific deal details and big number 50%

Comprehensive Estate Planning Questionnaire

Scott Bucy, Attorney at Lawosb # 181944‍541.631.9100Jessica@ashlandoregonlaw.comPO Box 718Ashland, Oregon 97520

Scott Bucy, Attorney at Law
osb # 181944
‍
541.631.9100
Jessica@ashlandoregonlaw.com

PO Box 718
Ashland, Oregon 97520