Estate Planning Form

Thank you for your interest in retaining this firm for your legal needs. Please review the following information regarding our billing, privacy, and file retention policies.

The submission of this information alone does not create an Attorney-Client relationship. Such a relationship may be formed only after reaching a representation agreement with one of our attorneys.

Initial Conference You will be charged for the initial conference and all subsequent conferences.

Telephone Conferences You will be charged for telephone conferences.

Billing Rates Billing rates for attorneys and paralegals are reviewed periodically and may be revised at any time. You will be charged for the attorney and staff time.

Estimate If we give you an estimate for the cost of our services, it is only an estimate. The estimated fee quoted may be greater or lesser than the actual charge depending upon the complexity of the matter, actions by other parties and their attorneys, and the amount of time actually incurred.

Expense You will be charged for out-of-pocket expenses incurred by us on your behalf including travel expenses.

Client Documents We will maintain all documents you furnish us in our client files for this matter. At the conclusion of each matter (or earlier if appropriate), it is your obligation to advise us as to which, if any, of the documents in our files you wish us to return to you. We may keep copies to the extent we believe advisable for our records. We will retain any remaining documents in our files, and our files will ultimately be destroyed.

GENERAL

Full name:(Required)

Date of birth:

Spouse’s full name:

Date of birth:

Address(Required)

Mailing address (if different):

Telephone:

Home:

Cell:(Required)

His cell phone:

Her work:

Her cell phone:

Email address:

Spouse:

Passwords:

You should always keep a list of all current passwords for all electronic devices with a copy of your Will.

If either spouse has been divorced, please furnish:

name of the person from whom the spouse is divorced

Date of divorce

County and state of divorce

LAST WILL AND TESTAMENT:

1. Children (include and indicate any deceased child or children):

[please designate if children are ours, his, or hers]

Name

Sex

Date of Birth

Name

Sex

Date of Birth

Name

Sex

Date of Birth

Name

Sex

Date of Birth

Name

Sex

Date of Birth

2. Please explain how you wish to distribute your assets on your death:

To each other:

Yes

if single or both spouses are deceased, explain how you wish to distribute your assets:

3. Executor: The law provides that a person that has been convicted of a felony may not serve as executor of an estate.

(a) Each other:

Yes

If not each other, then:

Name:

Address:

Phone:

(b) 1st alternate executor:

Name:

Address:

Phone:

(c) 2nd alternate executor, if any:

Name:

Address:

Phone:

4. Guardian of children:

Name:

Address:

Phone:

(b) 1st alternate guardian:

Name:

Address:

Phone:

(b) 2nd alternate guardian, if any:

Name:

Address:

Phone:

5. Trustee: (person who handles children’s property until children are of age)

Name:

Address:

Phone:

(b) 1st alternate trustee:

Name:

Address:

Phone:

(b) 2nd alternate trustee, if any:

Address:

Name:

Phone:

6. Date trust is to terminate:

Date trust is to terminate:

7. On death of a beneficiary of the trust, who is to receive your property:

On death of a beneficiary of the trust, who is to receive your property:

8. Value of estate (check one):

Value of estate (check one):

Over $11,000,000

Under $11,000,000

REVOCABLE LIFE ESTATE:

An individual may transfer his or her interest in real property to one or more beneficiaries effective at the transferor’s death by a Revocable Life Estate deed.

The deed is revocable at any time while a person is competent. The deed is a non-testamentary instrument which means no probate would be required on the death of the transferor.

Do you want a Revocable Life Estate deed:

Yes

If you want a Revocable Life Estate deed, please provide the following information:

Transferee’s name and address:

Alternate transferee’s name and address:

Address and description of the real property:

STATUTORY DURABLE POWER OF ATTORNEY:

1. Agent:

(a) Each other:

Yes

If not each other, then:

Name:

Address:

Phone:

(b) If desired, 1st alternate agent:

Name:

Address:

Phone:

(c) If desired, 2nd alternate agent:

Name:

Address:

Phone:

2. Please check the applicable space below if you want to authorize the following:

Special instructions applicable to agent compensation:

My agent is entitled to reimbursement of reasonable expenses incurred on my behalf and to compensation that is reasonable under the circumstances.

My agent is entitled to reimbursement of reasonable expenses incurred on my behalf but shall receive no compensation for serving as my agent.

Special instructions applicable to co-agents:

Each of my co-agents may act independently for me.

My co-agents may act for me only if the co-agents act jointly.

My co-agents may act for me only if a majority of the co-agents act jointly.

Do you want your durable power of attorney to:

be effective immediately; OR

be effective only upon your disability or incapacity?

If you select this alternative, it will require a physician to declare that you are disabled or incapacitated before the power of attorney becomes effective.

DURABLE MEDICAL POWER OF ATTORNEY AND DIRECTIVE TO PHYSICIANS:

1. Agent:

(a) Each other:

Yes

If not each other, then:

Name:

Address:

Phone:

(b) If desired, 1st alternate agent:

Name:

Address:

Phone:

(c) If desired, 2nd alternate agent:

Name:

Address:

Phone:

2. Do you want a directive to physicians (“Living Will”) which provides that your life will not be artificially prolonged?

Do you want a directive to physicians (“Living Will”) which provides that your life will not be artificially prolonged?

Yes

GUARDIANSHIP FOR YOU AND YOUR SPOUSE:

1. Do you want to appoint a guardian for you and your spouse if later an event occurs creating a need for a guardian?

Do you want to appoint a guardian for you and your spouse if later an event occurs creating a need for a guardian?

Yes

2. If yes, provide the following:

Guardian:

(a) Each other:

Yes

If not each other, then:

Name:

Address:

Phone:

(b) If desired, 1st alternate guardian:

Name:

Address:

Phone:

(c) If desired, 2nd alternate guardian:

Name:

Address:

Phone:

If you have a legal insurance plan, please provide the following:

Insurance Company

Member Name/ ID Number

Case Number

Last 4 Digits of Social Security Number

The best legal service is based on a friendly mutual understanding between an attorney and a client. We will endeavor to keep fees and expenses charged to you as low as reasonably possible. We will bill you on a monthly basis, and we request that you pay promptly. If you ever have any questions concerning an invoice, please contact us and we will be glad to address your questions. You agree to pay all charges upon receipt of invoice.

Confirm(Required)

I understand the submission of this information sheet alone does not create an Attorney-Client relationship. Such relationship may be formed only after entering into a representation agreement with one of our attorneys.

I confirm that I have read, consent, and agree to Sell Griffin McLain PC Privacy Policy and File Retention Policy.

I agree to Sell Griffin McLain PC payment terms and conditions.

Signature(Required)

Email(Required)