Overview and Instructions:

Please complete the information below and click the submit button at the bottom when you are satisfied with your answers. Someone from our office will follow up with you soon to go over your responses. * Denotes items that must be completed before submission.

To download a PDF version of the intake form before you begin, please click here.

Before you begin, watch the video below to learn about the four components of an estate plan.

Information About You

First Name*

Middle Name

Last Name*

Last Four of SS#*

Street Address*

City*

State*

Zip Code*

Phone Number*

Email*

Date of Birth*

Gender

Information About Your Spouse

First Name*

Middle Name

Last Name*

Last Four of SS#*

Street Address*

City*

State*

Zip Code*

Phone Number*

Email*

Date of Birth*

Gender

Information About Your Children

Child 1 Name

Middle Name

Last Name

Child 1 Parent

Child 2 Name

Middle Name

Last Name

Child 2 Parent

Child 3 Name

Middle Name

Last Name

Child 3 Parent

Child 4 Name

Middle Name

Last Name

Child 4 Parent

Child 5 Name

Middle Name

Last Name

Child 5 Parent

Child 6 Name

Middle Name

Last Name

Child 6 Parent

Questions / Comments about Children

Solve the Dilemma of Choosing an Agent

There are many things to consider when navigating your options for choosing the ones who will carry out your wishes. Watch the video to learn more.

Financial Agent

For the initial agent, married couples typically choose a spouse, and single people often choose a parent, sibling, or child, depending on their age. For married people, these people are often named as alternates. Before doing what most people do, though, consider whether the person has the knowledge and experience necessary to manage your financial matters. Choose someone you would trust with your checkbook, and if you have a business, choose someone would trust to run the business for you.

A professional financial fiduciary may be more appropriate if you have a more complicated family or financial situation or if the burden of managing your finances might be more than any of your family or close friends can handle. It is also often a good idea to name a professional fiduciary as your financial fiduciary of last resort, especially if you are unsure who to trust beyond one or two trusted individuals. Watch the video to learn more about designating someone to manage your finances.

Spouse as Initial Financial Agent

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Financial Agent 2

Please enter the information for your second choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Financial Agent 3

Please enter the information for your third choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Financial Agent 4

Please enter the information for your fourth choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Financial Agent

Please enter the information for your spouse’s first choice as a financial agent below.

Spouse as Initial Financial Agent

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Financial Agent 2

Please enter the information for your spouse’s second choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Financial Agent 3

Please enter the information for your spouse’s third choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Financial Agent 4

Please enter the information for your spouse’s fourth choice as a financial agent below.

Financial Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Questions / Comments about Financial Agents

Health Care Agent

When you need medical care, your doctor or the hospital is required to get your permission before beginning treatment. That permission can be difficult or even impossible to get if you are incapacitated or unconscious. Many times, hospitals will require a signed document authorizing a patient advocate to give this permission for you if you cannot. Without a signed document, hospitals and doctors may require a court order before providing non-life-saving treatment or before withholding treatment that you may not want.

A caregiver can also be nominated to assist with the coordination of your care upon discharge from the hospital. An advocate could make end of life and organ donation decisions, whereas a caregiver coordinator may just follow up to make sure you take your prescriptions get to appointments and other post-op care, or coordinate your caregiving in accordance with the wishes you select in our Caregiver Guide. To learn more about designating someone to manage your health care, watch the video below.

Spouse as Initial Health Care Agent

Health Care Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Health Care Agent 2

Please enter the information for your second choice as a health care agent below.

Health Care Agent 2 First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Health Care Agent 3

Please enter the information for your third choice as a helath care agent below.

Health Care Agent 3 First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Health Care Agent 4

Please enter the information for your fourth choice as a health care agent below.

Health Care Agent 4 First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Health Care Agent

Please enter the information for your spouse’s first choice as a health care agent below.

Spouse as Initial Health Care Agent

Health Care Agent First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Health Care Agent 2

Please enter the information for your spouse’s second choice as a health care agent below.

Health Care Agent 2 First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Health Care Agent 3

Please enter the information for your spouse’s third choice as a health care agent below.

Health Care Agent 3 First Name

Middle Name

Last Name

Area Code

Phone Number

Spouse’s Back-up Health Care Agent 4

Please enter the information for your spouse’s fourth choice as a health care agent below.

Health Care Agent 4 First Name

Middle Name

Last Name

Area Code

Phone Number

Questions / Comments about Health Care Agents

Health Care Decisions

We will prepare a document that guides your Patient Advocate regarding end-of-life medical care in case you become unable to communicate your decisions in the event you:

a. are declared to be in a permanent vegetative state with no reasonable chance of recovery (i.e. brain dead); or
b. have a terminal condition from which you are not reasonably expected to recover (collectively “Terminal Condition”).

Life-Prolonging Procedures: Life-prolonging procedures include the following:

a. Nutrition and hydration administered by invasive procedures;
b. Antibiotics;
c. Respirators, pacemakers, renal dialysis, or any other mechanical devices designed to assist the functioning of organs;
d. Transfusion of blood and blood products; and/or
e. Cardiac or cardiopulmonary resuscitative procedures or devices.

Cremation / Burial / Undecided: You may choose whether your remains are buried or cremated, or you may indicate that you are undecided and leave it up to your advocate to decide.

Organ Donation: Your registration on your Driver’s License as an Organ Donor will override your Patient Advocate’s decision; however, if you have not indicated a preference on your Driver’s License or if you want to make sure that your Patient Advocate is aware of it, indicate your preference below, and we will include it in your Patient Advocate Designation.

Organ Donation

Final Disposition of Remains

Spouse Organ Donation

Spouse Final Disposition of Remains

Questions / Comments about Health Care Decisions

Primary Beneficiaries

Please indicate who will be the Primary Beneficiaries of your Trust upon your death, or if you have a joint trust, upon the second to die of you and your spouse. Watch this short video learn more about designating beneficiaries.

Primary Beneficiary

If you selected other, please describe who you would like to inherit your property when you die. Please indicate percentages if your property will be split among two or more individuals or groups (50% to my siblings and 50% to my nieces and nephews, for example).

Primary Beneficiaries’ Names and Amounts

Questions / Comments about Primary Beneficiaries

Underage Beneficiaries / Delayed Distributions

For underaged beneficiaries, you may choose to delay their distributions from the Trust over a period of time from 5 to 20 years. Prior to that, your beneficiaries would receive distributions of income plus principal distributions for their Health, Education, Maintenance, and Support at the Trustee’s discretion.

Age Principal Distributions Start

Duration of Annual Principal Distributions

Questions / Comments about Underage Beneficiaries

Disinherited Individuals / Barred Fiduciaries

You may list up to 8 individuals or classes of individuals (e.g. “all of my children”) to disinherit, which will also include their descendants, unless you have specifically provided for the descendant as a primary or contingent devisee of your Trust. Our documents also will automatically treat divorced former spouses of you or a beneficiary as disinherited, as well, unless you have specifically provided for the divorced spouse as a primary or contingent beneficiary.

For each excluded beneficiary, you may choose to bar them from a fiduciary role as well for which they might otherwise have statutory standing (guardian, conservator, personal representative).

Disinherited Individuals/Barred Fiduciaries

Questions / Comments about Disinherited Individuals/Barred Fiduciaries

Contingent Beneficiaries

Upon the death of all of your Primary Beneficiaries, you can name contingent beneficiaries to receive their shares. You can name up to 8 different individuals, classes of individuals (e.g., our nieces and nephews), or charities. If you name no one, the Catastrophic Death Clause will dictate who receives your assets.

Describe Contingent Beneficiaries

Questions / Comments about Contingent Beneficiaries

Catastrophic Beneficiaries

In case of a catastrophic event, where none of your named beneficiaries are living at the time of your death, you may choose one of the following alternate groups of beneficiaries:

Your Heirs-at-Law Only
½ to Your Heirs-at-Law and ½ to Your Spouse’s Heirs-at-Law
Contingent Beneficiaries’ Heirs-at-Law pro rata

Heirs at law are those individuals who would receive your assets if you did not have a Will in the order and proportions as set by Michigan law, i.e. your spouse, your children, your parents, your siblings, your nieces and nephews, etc.

Please Describe Your Catastrophic Beneficiaries Below:

Questions / Comments about Catastrophic Beneficiaries

Guardians and Parental Delegates

If any of your children are under the age of 18, you can create a temporary guardianship by delegating your parental rights in the event something happens to you short of death. You can also nominate guardians to care for your children upon your death. Watch this video to learn more about designating someone to care for your children.

Guardian First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Guardian First Name

Middle Name

Last Name

Area Code

Phone Number

Parental Delegate First Name

Middle Name

Last Name

Area Code

Phone Number

Back-up Parental Delegate
First Name

Middle Name

Last Name

Area Code

Phone Number

Questions / Comments about Guardians and Parental Delegates

Assets

Please provide information about your assets below.

Own / Rent Home

Home Title

Home Value

Other Real Estate / Owner / Value

Retirement Account Type / Owner / Value

Retirement Account Value

Spouse Retirement Account

Life Insurance

Life Insurance Value

Spouse Life Insurance

Spouse Life Insurance Value

Other Assets

Liabilities / Debt

Please provide information about your liabilities below.

Liabilities / Debt

Income

Spouse Income

Social Security Income

Spouse Social Security Income

Pension

Spouse Pension

Other Income

Business Owner

Notes and Questions

Please list any notes or questions that you would like us to address when preparing your estate plan.

Review and Submit:

Please review the information above and click “submit” below when you are satisfied with your responses.

* Denotes items that must be completed before submission.

Overview and Instructions:

Information About You

Information About Your Spouse

Information About Your Children

Solve the Dilemma of Choosing an Agent

Financial Agent

Back-up Financial Agent 2

Back-up Financial Agent 3

Back-up Financial Agent 4

Spouse’s Financial Agent

Spouse’s Back-up Financial Agent 2

Spouse’s Back-up Financial Agent 3

Spouse’s Back-up Financial Agent 4

Health Care Agent

Back-up Health Care Agent 2

Back-up Health Care Agent 3

Back-up Health Care Agent 4

Spouse’s Health Care Agent

Spouse’s Back-up Health Care Agent 2

Spouse’s Back-up Health Care Agent 3

Spouse’s Back-up Health Care Agent 4

Questions / Comments about Health Care Agents

Health Care Decisions

Questions / Comments about Health Care Decisions

Primary Beneficiaries

Questions / Comments about Primary Beneficiaries

Underage Beneficiaries / Delayed Distributions

Questions / Comments about Underage Beneficiaries

Disinherited Individuals / Barred Fiduciaries

Questions / Comments about Disinherited Individuals/Barred Fiduciaries

Contingent Beneficiaries

Questions / Comments about Contingent Beneficiaries

Catastrophic Beneficiaries

Questions / Comments about Catastrophic Beneficiaries

Guardians and Parental Delegates

Questions / Comments about Guardians and Parental Delegates

Assets

Liabilities / Debt

Notes and Questions

Review and Submit:

Grand Rapids Area Office

Muskegon Area Office