Fillable Supplemental Estate Planning Intake Form Single Person printable pdf download

Supplemental Estate Planning Intake Form Single Person

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Supplemental Estate Planning Intake Form

Single Person

CLIENT: ______________________________________

Power of Attorney

1. Do you intend for the power of attorney to remain effective if you become

incapacitated?

Yes

2. Do you intend for the power of attorney to become effective upon execution of

document or upon the occurrence of a future event or at a future date (i.e. when you

become incapacitated)?

Effective when executed

Effective upon future occurrence or at future date

If you intend for the document to become effective upon the occurrence of a future

event or at a future date, please specify:

__________________________________________________________________

3. Please check any actions that you intend to expressly authorize in the power of

attorney: (CAUTION: Granting any of powers below will give your agent the

authority to take actions that could significantly reduce your property or change how

your property is distributed at your death)

Create a trust;

Amend, revoke, or terminate an inter vivos trust, even if specific

authority to do so is granted to the agent in the trust agreement;

Make a gift;

Create or change rights of survivorship;

Create or change a beneficiary designation;

Delegate authority granted under the power of attorney;

Waive the principal’s right to be a beneficiary of a joint and survivor

annuity, including a survivor benefit under a retirement plan;

Exercise fiduciary powers that the principal has authority to delegate

Supplemental Estate Planning Intake Form – Single Person – Version 14.1

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Supplemental Estate Planning Intake Form Single Person

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