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Kinghorn Law, LLC

3573 E. Sunrise Dr.
Suite 209
Tucson, AZ 85718
520.529.4000

Estate Planning
Investor Coaching

Estate Planning Consultation Form

"*" indicates required fields

Part 1

Date of Consultation*

MM slash DD slash YYYY

Marital Status*

Married

Single

Widowed

Divorced

First Name*

Middle Initial

Last Name*

Date of Birth*

MM slash DD slash YYYY

Phone Number*

Email Address

I am..*

A Veteran

A US Citizen

A Non-US Citizen

Retired

Select all that apply

Part 2

Spouse/Partner’s First Name

Spouse/Partner’s Middle Initial

Spouse/Partner’s Last Name

Spouse/Partner’s Date of Birth

MM slash DD slash YYYY

Spouse/Partner’s Phone Number

Spouse/Partner’s Email Address

My Spouse/Partner is…

Retired

A Veteran

A US Citizen

A Non-US Citizen

Select all that apply

Physical Address 1

Physical Address 2

City

State

ZIP

Mailing Address 1

Mailing Address 2

City

State

ZIP

Children

Child’s Full Name

Gender

Date of Birth

Parent(s)

Married (Y/N)

# of Grandchildren

Click the plus button to add more children

I have concerns about a special needs family member:*

Yes

No

Estate has the following assets (check all that apply):*

Annuities

Brokerage Accounts

Cash (Bank Accounts)

CD’s

IRA/Retirement Plans

Life Insurance

Precious Metals

Real Estate

Business/Partnerships

Certificates of Deposit

Other

Other Estate Assets Not Mentioned Above

Approximate gross value of my entire estate:*

Part 3 - What Really Matters to Me?

Please check one of the following boxes:*

I am ready to proceed with the creation of my plan.

My loved one is already in a nursing home. I am ready to proceed with a plan.

I am not interested in creating a plan at this time. I’m here for general information only.

I need the following questions answered before I am ready to proceed with the creation of my plan:

Additional questions to be answered

Please rate the following estate planning goals and concerns on a scale of 1 to 5.
(1 = Very Important / 5 = Not Important at All)

Make sure there’s a written plan to handle my affairs*

1

2

3

4

5

I want to avoid Living Probate and/or Death Probate*

1

2

3

4

5

Make sure nursing home costs don’t use up all my assets*

1

2

3

4

5

Make sure my wishes are honored regarding life support decisions*

1

2

3

4

5

After my death, I want my estate to stay with my children if they get divorced*

1

2

3

4

5

I want to minimize all Death Taxes*

1

2

3

4

5

Protect my life insurance from Death Taxes*

1

2

3

4

5

Protect my estate if my spouse gets remarried after my death*

1

2

3

4

5

After my death, protect my estate from my children’s creditors*

1

2

3

4

5

Protecting my special needs child after my death*

1

2

3

4

5

Funeral planning for my final arrangements and to make it easier for my family*

1

2

3

4

5

Consent*

I authorize the law firm to occasionally mail, fax or email information to me. I understand that I can unsubscribe to communication from the firm at any time and I also understand that the law firm will not share or sell my contact information to anyone. I prefer to be contacted at the email address listed above.

Signature*

Please type your full name to act as your digital signature.

Estate Planning
Elder Law – Medicaid and VA
Probate and Trust Administration
Events

Team
Firm
Comprehensive Planning
Estate Planning Reviews
Blog
Contact

Inquiries

info@kinghornlaw.com
Kinghorn Law, LLC

3573 E. Sunrise Dr.
Suite 209
Tucson, AZ 85718
520.529.4000

Join Our Team Estate Planning Investor Coaching

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