Confidential intake

Estate Planning Information Form

This intake collects the information our office needs to prepare your estate plan. Please complete it to the best of your ability — leave anything blank that you'd prefer to discuss in person.

If you are filing as a couple, one of you may complete this form for both. Each spouse must, however, complete their own Health Care Directive section.

Your progress is saved automatically to this device. Nothing is transmitted to our office until you choose to send it.

Approx. 25–35 minutes

Section 1

Client 1 — About you

Please use your full legal name as it appears on your government-issued ID.

Identification

Legal first name

Middle name(s)

Legal last name

Preferred name

Pronouns

Date of birth

Place of birth

U.S. citizen?

Other legal names ever used

Contact

Street address

Apt / unit / P.O. Box

City

State

ZIP

County

Home phone

Mobile phone

Work phone

Email

Preferred email

Preferred contact method

OK to leave voicemail?

Background

Occupation

Employer

Marital status

Military service (branch / rank / dates)

Overall health

Religion (if relevant to plan)

Anything urgent (pending surgery, travel, etc.)

Section 2

Client 2 — Spouse or partner

If you are completing this form as a couple, please provide the same information for your spouse or partner. You — the filer — may complete this on their behalf, though they must complete their own Health Care Directive (Section 22).

Is there a Client 2?

Yes — please collect their information No — single client

Section 3

Marriage details

Complete only if you and Client 2 are married, engaged, or in a domestic partnership.

Union

Date of marriage / partnership

Place of marriage

Premarital / postnuptial agreement?

Plan type

Prior marriages

Client 1 — prior marriages

Client 2 — prior marriages

If either of you has been previously married, to whom and how was the marriage terminated?

Section 4

Children & dependents

List ALL children — including deceased children, children born outside marriage, children from prior relationships, and any child you intend to exclude from your estate plan.

Children

Treatment

Has any child received an advance on their inheritance, or do any children owe you money?

Is there any reason NOT to treat your children equally?

Do you wish to include grandchildren born outside of marriage?

Other family context

Parents living?

Any parent or sibling who depends on you?

Anything else about your family we should know going in?

Section 5

Personal Representative (Executor)

Your Personal Representative — historically called the "executor" — is the person who will settle your estate after your death.

Primary Personal Representative

Name

Relationship to you

Address

Phone

Email

Successor Personal Representative

Name

Relationship

Address

Phone

Email

Instructions or guidance

Section 6

Trustee

A trustee manages assets placed in a trust — for your children, your spouse, or other beneficiaries — until they reach specified ages. May be the same person as your Personal Representative.

Primary trustee

Same as Personal Representative?

Name (if different)

Relationship

Phone

Address

Successor trustee

Name

Relationship

Address

Instructions or guidance

Section 7

Financial Power of Attorney

A Financial Power of Attorney appoints someone (your "attorney-in-fact") to manage your financial affairs if you become unable to do so.

Primary attorney-in-fact — Client 1

Name

Relationship

Address

Phone

Successor attorney-in-fact — Client 1

Name

Relationship

Primary attorney-in-fact — Client 2

Name

Relationship

Address

Phone

Successor attorney-in-fact — Client 2

Name

Relationship

Authority & mechanics

When should the POA take effect?

May the attorney-in-fact make gifts to themselves or others they support?

Should the attorney-in-fact be required to provide an accounting?

To whom?

Section 8

Guardians for minor children

If you have children under 18, who should raise them — and who should manage their inheritance — if you cannot?

Applicable?

Yes — we have or will have minor children No / not applicable

Personal guardian (raises the children)

Primary — name

Relationship

Address

Have you spoken with them?

Backup — name

Backup — address

Estate guardian (manages money for the children)

Same as personal guardian?

If different — name

Distribution plan

At what age should children receive their inheritance outright?

Permitted distributions before then

Specific instructions or guidance for the guardian

Section 9

Beneficiaries

Who do you want your assets to go to, and in what proportion?

Default distribution scheme

To my spouse, then to my children equally most common Directly to my children, equally To my children, but not equally A more bespoke arrangement I have no spouse or children — let me describe

Primary beneficiaries

List each person or organization and the share you intend.

If a beneficiary dies before you

Their share passes to their own descendants per stirpes Redistributed among surviving beneficiaries Depends — discuss with attorney

If your entire family does not survive you

Disinheritance

Section 10

Specific bequests & cash gifts

Particular items or specific sums you wish to leave to particular individuals or organizations.

Tangible bequests

Cash gifts

Memorandum of personal property

Many clients prefer to list smaller items separately, in a memorandum updateable without re-doing the will.

Yes, I'd like a memorandum No, list everything in the will Discuss with attorney

Section 11

Charitable giving

Causes and institutions you wish to support through your estate.

Charities

Interested in advanced charitable vehicles?

Triggers a conversation with your attorney; no commitment here.

Donor-advised fund Charitable remainder trust Charitable lead trust Private family foundation Qualified charitable distribution from IRA I'd like to learn about options

Section 12

Assets — detail

For each significant asset, list institution, ownership, and approximate value. Account numbers are not needed here — bring statements to the consultation.

Real estate

Financial accounts

Banking, brokerage, retirement, education, HSA, annuity, etc.

Life insurance

Business interests

LLCs, partnerships, closely-held shares, with any buy-sell or succession provisions.

Other valuable property

Section 13

Assets — summary table

Roll-up by ownership. Enter approximate values; rounding to the nearest thousand is fine.

Asset	Client 1	Client 2	Joint
Real estate
Home (primary residence)
Other real estate
Bank & investment
Checking accounts
Savings accounts
Money market
Investment / brokerage
Retirement
IRA (Traditional / Roth)			—
401(k) / 403(b) / Pension			—
Annuities
Other
Life insurance — cash value
Automobiles
Personal property (general)
Closely-held business interest(s)
Other
Total assets	$0	$0	$0

Section 14

Liabilities — detail

For each significant debt or obligation, identify the creditor, type of debt, current balance, and who is responsible.

Liabilities

Mortgages, lines of credit, loans, credit cards, tax obligations — anything you owe.

Section 15

Liabilities — summary table

Approximate balances — same ownership breakdown as assets.

Liability	Client 1	Client 2	Joint
Home mortgage
Other mortgages
Auto / secured loans
Credit cards / consumer
Student loans			—
Debts to family members
Business / personal guarantees
Other (taxes, judgments, alimony, support)
Total liabilities	$0	$0	$0

Estimated net worth (combined)

$0

Section 16

Beneficiary designations

Many assets pass by beneficiary designation rather than under your Will — life insurance, retirement accounts, and any account with a TOD/POD designation. Please describe what is currently on file.

Life insurance — primary and contingent beneficiaries

Retirement plans (401(k), IRA, pension)

Death benefit on retirement plan?

Plan has a death benefit?

If yes, who is the named beneficiary?

TOD / POD designations on other accounts

Section 17

Safe deposit box & personal property

Safe deposit box

Do you have a safe deposit box?

Location (bank, branch)

Who else has access?

Where is the key located?

Who, besides Client 1 and Client 2, knows the box exists?

Items of substantial value

Automobiles, art, jewelry, collectibles, firearms, boats, etc. Include any items separately scheduled on a homeowner's insurance rider.

Section 18

Lifetime gifts, expected inheritances, and guarantees

Gift tax history

Has either of you ever filed a gift tax return?

If yes, when?

Reportable lifetime gifts

Gifts above the annual exclusion in any single year.

Future inheritances

Loan guarantees

Section 19

Special situations

A series of yes/no questions that flag specific drafting needs. We will follow up on any "yes" answers at our consultation.

Property

Family

Tax & planning

Other

Anything you'd like to explain

Section 20

Pets & companion animals

Do you have any pets you wish to provide for?

Yes No

Your pets

Caretaker & funding

Primary caretaker

Backup caretaker

Amount to set aside for care

If no human caretaker is available

Section 21

Digital legacy

Online accounts, cryptocurrency, digital media, and password storage. We do not want passwords here — only your wishes and the people who should act on them.

Authority to access online accounts

Client 1 — grant access?

Client 2 — grant access?

Digital executor

Name

Relationship

What should happen to your accounts?

Memorialize where possible Delete everything Let my digital executor decide

Password storage

Password manager (1Password, etc.) Written somewhere In my head No clear system

Cryptocurrency & digital assets of value

Sentimental digital content

Section 22

Health Care Directive — Client 1

Client 1 must complete this section personally. These choices become your living will and govern medical decisions if you cannot speak for yourself.

Healthcare agent

Primary agent — name

Relationship

Address

Phone

Email

Successor agent — name

Relationship

Successor — phone

Address

HIPAA authorization

Existing living will / directive

Do you already have a Health Care Directive?

If yes, date of instrument

Revoke any prior healthcare directives?

If in a terminal condition with no realistic chance of recovery

Let me go naturally — comfort care only Try everything reasonable Defer to my healthcare agent

If in a persistent vegetative state

Withdraw life-sustaining treatment Continue life-sustaining treatment Defer to my agent

Artificially provided nutrition & hydration

Provide Withhold Defer to my agent

Pain management

Prioritize comfort, even if it shortens life Balanced Conservative

Organ donation

Yes — any purpose Yes — transplantation only No Defer to my agent

Funeral, burial, & remembrance

Disposition

Religious / cultural traditions

Prepaid funeral plan?

Primary physician

Other wishes (place, music, readings, what you'd like said)

Section 23

Health Care Directive — Client 2

Client 2 must complete this section personally. Even though Client 1 may have completed everything else in this form, each spouse must independently express their own healthcare wishes.

Healthcare agent

Primary agent — name

Relationship

Address

Phone

Email

Successor agent — name

Relationship

Successor — phone

Address

HIPAA authorization

Existing living will / directive

Do you already have a Health Care Directive?

If yes, date of instrument

Revoke any prior healthcare directives?

If in a terminal condition with no realistic chance of recovery

Let me go naturally — comfort care only Try everything reasonable Defer to my healthcare agent

If in a persistent vegetative state

Withdraw life-sustaining treatment Continue life-sustaining treatment Defer to my agent

Artificially provided nutrition & hydration

Provide Withhold Defer to my agent

Pain management

Prioritize comfort, even if it shortens life Balanced Conservative

Organ donation

Yes — any purpose Yes — transplantation only No Defer to my agent

Funeral, burial, & remembrance

Disposition

Religious / cultural traditions

Prepaid funeral plan?

Primary physician

Other wishes

Section 24

Existing documents

What's already in place?

Last Will and Testament Revocable Living Trust Irrevocable trust(s) Financial Power of Attorney Health Care Directive / POA HIPAA authorization Pre/Postnuptial agreement Buy-sell / operating agreement None of these

Please bring copies of any of the above to your consultation.

Where are originals kept?

Prior attorney

Firm / name

OK to contact for prior documents?

Section 25

Professional team

Optional — leave any of these blank if you don't have a current relationship. We'll coordinate with your other advisors only with your permission.

Accountant / CPA

Name

Firm

Phone

Email

Financial advisor

Name

Firm

Phone

Email

Insurance advisor

Name

Firm / carrier

Phone

Email

Primary physician — Client 1

Name

Practice / clinic

Phone

Address

Primary physician — Client 2

Name

Practice / clinic

Phone

Address

Section 26

Final notes

Objectives and goals

In your own words, what would you like to accomplish? You may consider: asset protection for descendants, estate & gift tax planning, intergenerational planning, simplification of estate administration, charitable objectives.

Specific concerns

Family involvement

Include family in the planning process?

Letter of intent / ethical will?

How did you find Messick Law?

Source

Whom should we thank?

Scheduling

Best days & times for the consultation

In person or remote?

Questions for us

Section 27

Review & submit

A summary of your intake. Click any section to jump back and edit. When ready, download a copy for your records and bring it — or send it — to your consultation.

Acknowledgement

By submitting this intake you confirm that the information provided is accurate to the best of your knowledge and that you understand this questionnaire does not by itself create an attorney-client relationship.

Client 1 signature (type your name)

Date

Client 2 signature (type your name)

Date

Estate Planning Information Form

Client 1 — About you

Client 2 — Spouse or partner

Marriage details

Children & dependents

Personal Representative (Executor)?

Trustee?

Financial Power of Attorney

Guardians for minor children

Beneficiaries

Specific bequests & cash gifts

Charitable giving

Assets — detail

Assets — summary table

Liabilities — detail

Liabilities — summary table

Beneficiary designations

Safe deposit box & personal property

Lifetime gifts, expected inheritances, and guarantees

Special situations

Pets & companion animals

Digital legacy

Health Care Directive — Client 1?

Health Care Directive — Client 2

Existing documents

Professional team

Final notes

Review & submit

Clear all answers?

Thank you

Personal Representative (Executor)

Trustee

Health Care Directive — Client 1