CONFIDENTIAL PLANNING SURVEY

Step 1 of 5

- If completing this form for another person, please complete it using that person’s information.
- Click “submit” when finished. (This form does NOT allow you to partially complete it and return to the form to enter additional information. If that is your preference, please use the PDF fillable option.)
- Please bring to your consultation any wills, trusts, powers of attorney, health care surrogates and living wills you may have.
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PART 1: FAMILY INFORMATION
Your Legal Name*
Street Address
City
State
Zip
County of Residence
Date of Birth
Phone
Email*
Spouse's Legal Name
Date of Birth
Phone
Email

PART 4: THINGS TO CONSIDER PRIOR TO YOUR CONSULTATION
WHO WILL HANDLE YOUR AFFAIRS?

These are the individuals who you wish to serve in various capacities under your estate plan. Consider both a primary and an alternate. We will discuss your choices with you.

Trustee under your Living Trust: Responsible for managing property titled in the name of your Living Trust. Most people make themselves the initial Trustee(s), and designate Successor Trustee(s) who will serve when they can no longer act due to disability, or death.

Personal Representative under your Last Will & Testament: Responsible for probating your Will, if probate is necessary, and administering your probatable assets.

Health Care Surrogate: Responsible for making your health care decisions in the event you cannot do so yourself. Decisions include but are not limited to terminating life supports, consenting to/refusing surgery and medical procedures, obtaining medical records, admitting you to a nursing home.

Agent under your Durable Property Power of Attorney: Responsible for handling your personal financial affairs that are not in your Trust, including, but not limited to, real estate sales, bank account transactions, execution of contracts, tax returns and motor vehicle registrations.

Guardians, if you have minor children: A “Guardian of the Person” will care for minor child under age 18 should parents pass away. A “Guardian of the Property” handles the child’s finances.

Beneficiaries: These are the individuals (and/or organizations) you wish to receive your assets upon your death. We will discuss your beneficiaries with you during your consultation.
PART 5: YOUR QUESTIONS/ADDITIONAL INFORMATION
Please use the space below to list any specific concerns and questions you wish to address during your consultation, or to expand on any of the answers you have provided.
Questions/Addendum
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How did you hear about The Karp Law Firm?
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Thank you for providing this information. We look forward to meeting with you. The Attorneys & Staff of The Karp Law Firm