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Single Estate Plan Intake Form

Please fill this form out to the best of your ability without taking too much time on it.  We can always update information later.

Please enable JavaScript in your browser to complete this form.Contact Information – Step 1 of 9

Contact Information

Name:

Preferred name, nicknames, maiden names, previous names, etc.

Date of Birth:

Preferred method of communication:
Home Address

Employment Status:

Residency

U.S. Citizen:
Date Established:

Have you filed for the Homestead exemption in your residence state?
Do you own property in a foreign country?

Do you have any of the following outside of your state of residence or domicile? Please check all that apply:

Marriage and Family

Have you been married previously?
Do you have any financial obligations from a prior marriage?

Is there any family member of your family that is disabled or receives medical benefits from a State or the Federal Government?
Are there any medical issues or procedures we should be aware of for planning purposes?
Are you receiving Social Security, disability, or other government benefits?

Children Contact Information

Children listed in this section will not be contacted. Please provide as many details as you can. If you have no children, you may move on to the next section by clicking “Next”.

First Child

Child's Name

Date of Birth

Is this child adopted?
Child Address

Marital Status
Do they have any children?

Do you have another child? 2

Second Child

Child's Name

Date of Birth

Is this child adopted?
Child Address

Marital Status
Do they have any children?

Do you have another child? 3

Third Child

Child's Name

Date of Birth

Is this child adopted?
Child Address

Marital Status
Do they have any children?

Do you have another child? 4

Fourth Child

Child's Name

Date of Birth

Is this child adopted?
Child Address

Marital Status
Do they have any children?

Name: First, Middle, Last ; Date of Birth ; Address ; Primary Phone Number ; Marital Status ; Number of Children

Real Estate

Please list any real estate that you own (outside of your own home).

Add another property 2
Add another property 3
Add another property 4

Banking Information

Please list your banking information below.

Add another account 2
Add another account 3
Add another account 4

Brokerage Account Information

Add another brokerage account 2
Add another brokerage account 3
Add another brokerage account 4

Automobiles

Add Automobile 2
Add Automobile 3

Life Insurance

Please fill as many fields as is necessary. You may skip any extra fields.

Profit Sharing, IRA, Pension Plans, 401K, Etc.

Add PS, IRA, PP, 401k, etc 2
Add PS, IRA, PP, 401k, etc 3
Add PS, IRA, PP, 401k, etc 4

Liabilities

Business or Trust Interests, Inheritance, and Previous Estate Plans

For any document that you have checked ‘Yes’ on, please provide a signed copy at your appointment.

Do you have an existing will?
Do you have an existing Trust?
Do you have any interest under a Will or Trust of another person, including a Power of Appointment?
Are you a Trustee of any Trust?
Do you expect to receive any inheritances?
Have you received or do you anticipate receiving any gifts or bequests from someone who expatriated from the U.S.?
Have you ever filed a corporate or partnership tax return?
Do you hold stock in a closely-held corporation?
Type of Entity

Have you given away more than the annnual gift tax exclusion, in money or property, to any person in a single year? (Annual exclusion was $3,000 until 1982, then $10,000, with modest increases beginning in 2002.)

Gift tax return?

Gift tax return? 2

Gift tax return? 3
Add recipient? 2
Add recipient? 3

Estate Plan

Trust Package includes: Revocable Trust, Healthcare Surrogate, Durable Power of Attorney, Living Will, Last Will and Testament.
Will Package includes: Healthcare Surrogate, Durable Power of Attorney, Living Will, Last Will and Testament.

Please check the documents that you are interested in executing for your estate plan.

Who will serve as the trustee?

First Appointment

Address

Alternate Appointment

Address

Second Alternate

Address

Who will serve as the personal representative of your will?

First Appointment

Address

Alternate Appointment

Address

Second Alternate

Address

Who will serve as attorney-in-fact under a durable power of attorney?

First Appointment

Address

Alternate Appointment

Address

Second Alternate

Address

Who will serve as healthcare surrogate/agent (person to make medical decisions)?

First Appointment

Address

Alternate Appointment

Address

Second Alternate

Address

Who will serve as surrogate for your Living Will (medical directive)?

First Appointment

Address

Alternate Appointment

Address

Second Alternate

Address

Document Upload

If you can upload any of the following documents, please do so below. However, if you prefer, you may provide physical copies at your consultation.

Check the box of all the documents you are uploading below:



Click or drag a file to this area to upload.


Alex Gillen is an attorney available for consultation in Stuart, Palm City, Sewall’s Point, Jensen Beach, Rio, Hutchison Island, Hobe Sound, Jupiter Island, Indiantown, Port St. Lucie, Tradition, Fort Pierce, Vero Beach, Sebastian, West Palm Beach, Palm Beach Gardens, Martin County, St. Lucie County, Indian River, and Palm Beach County practicing in estate administration (probate), trust administration, wills, trusts, estate planning, real estate, title insurance, and business law.

Contact Us

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© 2021 Alexander E.Gilen Attorney at Law
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Alex Gillen is an attorney available for consultation in Stuart, Palm City, Sewall’s Point, Jensen Beach, Rio, Hutchinson Island, Hobe Sound, Jupiter Island, Indiantown, Port St. Lucie, Tradition, Fort Pierce, Vero Beach, Sebastian, West Palm Beach, Palm Beach Gardens, Martin County, St. Lucie County, Indian River, and Palm Beach County practicing in estate administration (probate), trust administration, wills, trusts, estate planning, real estate, title insurance, and business law.

Contact Us

Office Address:
705 SE 5th Street
Stuart, FL 34994

Info@agillen.com

Phone: 772-774-7781

Fax: 772-494-5838

Mailing Address:
PO Box 777
Stuart, FL 34995

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© 2023 Alex Gillen, Attorney at Law