Individual Form - Law offices of Kimberly Powers, S.C.

Name:

Legal Surname:(Required)

Last

First Name:(Required)

First

Address:

Primary Address(Required)

Street Address County City, Town, Village State ZIP Code

Email(Required)

Provide us a personal email only. If you use your employer email/your work email, you waive privacy and you give permission to your employer to access and read your emails and view your confidential information.

Phone:

Date of Birth:(Required)

Plan Information:

PrePaid Legal Plan Holder:

First Last

Employer:

Last 4 of SSN:

Case Number:

Identification Code/Number

Eligibility Identification Code

NOMINATED Agents / Representatives / Trustees / Guardians: (First usually being spouse to spouse…but can be anyone you trust to serve in the different capacities) Please also provide names and contact information for alternate agents:

Health Care Power of Attorney:

First person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Health Care Power of Attorney:

Second person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Durable Power of Attorney (Finances and Property):

First person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Durable Power of Attorney (Finances and Property):

Second person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Trustee / Personal Representative:

First person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Trustee / Personal Representative:

Second person to act on your behalf.

Name

First Last

Email

Phone

Address

Street Address County City, Town, Village State ZIP Code

Guardian (should you need and only if different than Heath Care or Durable Power of Attorney agents nominated above):

Name

First Last

Other:

Please give a brief overview of your assets, special directions for minor children including guardians if necessary, special provisions for pets or charitable giving, etc…

Assets:

(click the + on the right side to list multiple)

Guardians for Minor Children:

Name

First Last

Email

Phone

Name

First Last

Email

Phone

Pets:

List Pets:

(click the + on the right side to list multiple)

Real Estate:

Please provide Tax Key/Legal Description/Copy of existing deed in the event real property will be transferred to trust.

Estate #1

Address

Street Address County City, Town, Village State ZIP Code

Tax Key

Legal Description

Copy of Existing Deed

Max. file size: 200 MB.

Estate #2

Address

Street Address County City, Town, Village State ZIP Code

Tax Key

Legal Description

Copy of Existing Deed

Max. file size: 200 MB.

Copy of Last Deed to Real Estate

Max. file size: 200 MB.

Copy of Title Insurance

Max. file size: 200 MB.

Copy of Tax Bill to the Property

Max. file size: 200 MB.

Estate Planning Information / Checklist (Individual)

Name:

Address:

Plan Information:

Beneficiaries / Children #1

Beneficiaries / Children #2

Beneficiaries / Children #3

Beneficiaries / Children #4

Beneficiaries / Children #5

NOMINATED Agents / Representatives / Trustees / Guardians: (First usually being spouse to spouse…but can be anyone you trust to serve in the different capacities) Please also provide names and contact information for alternate agents:

Health Care Power of Attorney:

Health Care Power of Attorney:

Durable Power of Attorney (Finances and Property):

Durable Power of Attorney (Finances and Property):

Trustee / Personal Representative:

Trustee / Personal Representative:

Guardian (should you need and only if different than Heath Care or Durable Power of Attorney agents nominated above):

Other:

Guardians for Minor Children:

Pets:

Real Estate:

Estate #1

Estate #2

Law offices of Kimberly Powers, S.C.

Lake Geneva Office Location:

Waukesha Office Location:

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