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

The information you provide on these forms will be used to prepare and maintain our official documentation. Please ensure that all details entered are accurate and complete, including full names and other identifying information- exactly as you would like it on your documents . Providing correct information helps us keep our records consistent and reliable. All agents must reside within the United States.

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)

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:

Law offices of Kimberly Powers, S.C.

Lake Geneva Office Location:

Waukesha Office Location:

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