Estate Planning Intake Form

Please complete the following form. If you are unsure what to put or whether a question applies to your situation, you may type NA or Unsure in the field. All fields must be filled in. Additionally, when giving information about a minor, please provide the email and phone number for the child’s guardian instead of the child.

"*" indicates required fields

Today's Date

PERSONAL INFORMATION

Preferred Name:

Complete Legal Name:

Present Address:

Address City State Zip Code

Home Phone:

Cell:

Date of Birth:

Marital Status:

EMPLOYMENT/BUSINESS

Name of Name Business/Employment:

Business Address:

Address City State Zip Code

Phone:

Type of Business:

Form of Ownership (sole propiertor, partner, limited partner, corporation, other):

CASH, BANK ACCOUNTS, CERTIFICATES OF DEPOSIT INFORMATION

Value

Name on Account:	Account Type:	Bank/Institution:	Number:	Maturity Date:	Actions

Add Values

REAL PROPERTY INFORMATION

(Include Residential, Business, Recreational, Rental, Timeshare, Foreign Real State, Other)

Type:	Name(s) on Title:	Assessed Value:	Actions

Add Values

SECURITIES, STOCKS, BONDS, GOVERMENT BONDS INFORMATION

STOCKS

Title:	Company Name:	Actions

Add Values

U.S. SAVING BONDS

Title:	Serial Number:	Date of Issue:	Actions

Add Values

BONDS

Title:	Issuer:	Maturity Date:	Value at Maturity:	Actions

Add Values

INSURANCE AND ANNUITIES

Untitled

Insurer:	Beneficiary:	Policy Number	Amount:	Actions

Add Values

MOTOR VEHICLES AND OTHER VEHICLES (BOATS, CAMPERS, MOTORBIKES, ETC.)

Make, Model, Year	Titleholder	Actions

Add Values

ASSETS

Personal Effects

Home (Principal)

Other Real Estate

Bank Accounts & Certificates of Deposit

Marketable Securities

Non-Marketable Sec.

Business Interests

Life Insurance

IRAs or Similar Accts

Current Debts Bank

Other

Total

LIABILITIES

Pension or Profit-Sharing Benefits

Loans

Mortgages Payable

Income Taxes

Life Insurance Loans

Other Debts

Total

Estimated Combined Present Net Worth:

OTHER ASSETS

Are you currently a beneficiary of an estate or trust? (Includes trusts where you have an expectancy after a prior interest):

Yes

Name of Estate/Trust	Relationship	Trustee	Value of Your Interest	Actions

Add Values

Do you have any expected inheritances from your parents or other relatives: If yes, please state:

Yes

Person Who May Leave You Something	Relationship	Age	Value of Your Interest	Actions

Add Values

CHILDREN AND STEP-CHILDREN

Name:	Sex:	Relationship	Present Address:	Cell Phone:	E-mail	Date of Birth:	Date of Death:	Actions

Add Values

GRAND CHILDREN

Name	Address	Sex	Date of Birth:	Parent Name:	Actions

Add Values

INFORMATION FOR LAST WILL AND TESTAMENT

EXECUTOR/EXECUTRIX

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Cell Phone

E-mail:

If above named agent is not available:

ALTERNATE EXECUTOR 1

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Cell Phone

E-mail:

ALTERNATE EXECUTOR 2

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Cell Phone

E-mail:

GUARDIAN FOR MINOR CHILDREN

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Cell Phone

E-mail:

ALTERNATE AGENT 1

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Cell Phone

E-mail:

AGENT UNDER DURABLE POWER OF ATTORNEY

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Home Phone:

Work Phone:

Ext.:

Cell Phone:

E-mail:

If above named agent is not available:

ALTERNATE AGENT 1

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Home Phone:

Work Phone:

Ext.:

Cell Phone:

E-mail:

HEALTH CARE AGENT

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Home Phone:

Work Phone:

Ext.:

Cell Phone:

E-mail:

If above named agent is not available:

ALTERNATE AGENT 1

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Home Phone:

Work Phone:

Ext.:

Cell Phone:

E-mail:

ALTERNATE AGENT 2

Name:

Sex:

Relationship:

Present Address:

Address City State Zip Code

Home Phone:

Work Phone:

Ext.:

Cell Phone:

E-mail:

OTHER INFORMATION / ESTATE PLANNING GOALS

Engagement Agreement

1. THE PARTIES / EFFECTIVE DATE. This Agreement is made between Nikki Woo Law & Associates ("Attorney") and You ("Client") and is effective as of the latest date of signing by Client.

2. LEGAL SERVICES PROVIDED, RESPONSIBILITIES OF ATTORNEY AND CLIENT. The Legal Services to be provided by Attorney to Client are the completion of a client's chosen Estate Plan and or document preparation only. All additional services are at an additional charge. Attorney will perform the Legal Services called for under this Agreement, keep Client informed of progress and developments, and respond promptly to Client's inquiries and communications. Client will cooperate with Attorney, be available as requested, provide necessary declarations, promptly pay all fees and costs, and keep Attorney informed of client's whereabouts and current street address, telephone number(s), fax number, and e-mail address at all times.

3. FEE. The agreed upon Flat Fee for the Legal Services agreed to by the Attorney and Client is due and payable at the execution of this agreement. The rules of professional conduct for attorneys in the state of Georgia in the United States of America require that unearned clients fees advanced by clients to attorneys be kept in a separate "trust' account until the fees are earned and/or the representation terminated by either party. This is because funds held in a trust account are generally protected from a law firm's creditors and cannot be spent until earned. For these reasons funds held in a trust account are more readily available to be refunded to clients. However, clients may waive this requirement. Due to the small nature of the Flat Fee and the administrative issues involved with moving the money between accounts, You hereby waive the requirement and allow the funds to be deposited into Nikki Woo Law & Associates' operating account. By waiving this requirement the Flat Fee becomes property of Nikki Woo Law & Associates upon receipt. The Legal Services are completed and the Flat Fee is earned when Attorney provides the receipt of Estate Plan and or agreed upon services. Client may be entitled to partial refund if the Client terminates this agreement prior to the completion of Attorney completing the Legal Services

4. COSTS AND EXPENSES. Governmental application or filing fees are in addition to the agreed upon Attorney fee.

5. WORK PRODUCT: The writings, notes, memoranda, reports of conversations, research and confidential materials which we prepare will be maintained in strict confidence and under the provisions of the attorney-client privilege.

6. TERMINATION: As is appropriate in any professional relationship, You may terminate our engagement at any time upon reasonable notice to us, and we retain the right to terminate this agreement as well. In the event that our representation is terminated, You agree to pay all bills thereafter rendered covering expenses incurred prior to the termination.

7. ENTIRE AGREEMENT / SEVERABILITY. This Agreement contains the entire agreement of the Parties. No other agreement, statement, or promise made on or before the effective date of this Agreement will be binding on the Parties. If any provision of this Agreement is held by a court or other tribunal of competent jurisdiction, in whole or in part, to be unenforceable for any reason, the remainder of that provision and of the entire Agreement will be severable and remain in effect.

8. FORM OF SIGNATURES. This agreement may be executed by the parties in electronic counterparts.

Agreed To And Accepted By:

Nikki Woo Law & Associates:

Nedra Woods, Esq

Date

Your Signature. Please Type Your Name Here:*