Get Started – Single

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Address

Primary Email

Country

Additional Details

Your Legal Name

Other Names used by You

Date of Birth×

Employment

US citizen?*

Yes

If no, what nationality

Social Security No

Work #

Marital Status*

Never married

Divorced

Widowed

Married

If married, name of Spouse:

CHILDRENS

None

Enter details of children

Click Yes or No for the following questions

	Yes	No
	Yes	No
Any deceased children?
If yes, survived by issue?
Any adopted children?
Do any of your beneficiaries have a learning disability, special educational, medical or physical needs?
Do you have any relatives (other than children) who depend on you for all or part of their support?
Do you think any of your beneficiaries have special problems with spouses, drugs, alcohol or handling money?
Do you wish to disinherit any of your children, grandchildren or any other close relative?
If a named beneficiary dies before you, do you want the assets to go to that beneficiary’s issue?
Do you want assets passing to your beneficiaries to be held in trust until a specific age or ages?
Do either of you expect to inherit substantial assets ($100,000 +)?
Do you have existing Wills?
Have you ever executed a trust (either revocable or irrevocable)?
Have you ever filed a Federal Gift Tax Return?
Do you have an existing General Power of Attorney?
Do you currently hold any assets in Joint Tenancy with another person?

The name of the person(s) that you want to be the decision maker concerning your estate upon your death:

Please list 4 names

The name of the person(s) that you want to raise a child that is under 18 (if applicable):

Please list 4 names

The name of the person(s) that you want to make any major medical decisions on your behalf:

Please list 4 names

In general, state how you want your estate distributed among your beneficiaries?

To my children equally

In general, state how you want your estate distributed among your beneficiaries?

Contingent beneficiary if you and your children all pass away

• State any specific concerns (not already mentioned) that you have regarding the distribution of your estate:

Enter your EOL Decisions

(a) Choice Not to Prolong Life I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits,

Signature

(b) Choice to Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Signature

Click Yes or No for the following questions

	Yes	No
	Yes	No
Should your health care agent have the authority to make a disposition of a part or parts of your body (i.e., make any anatomical gifts)?
Should your agent have the authority to authorize an autopsy even if an autopsy is not required by law?
Do you wish to designate a primary physician?

Enter your Burial Wishes

At my death, I wish to be*

Cremated

Buried

If cremation, I would like my ashes disposed as follows:

If buried, I would like my remains interred as follows:

I have already made arrangements at:

	ESTIMATED VALUE ($)
	ESTIMATED VALUE ($)
REAL ESTATE (fair market value, less loans)	ESTIMATED VALUE ($)
SECURITIES (stocks, bonds, mutual funds)	ESTIMATED VALUE ($)
CASH TYPE ASSETS (cash, annuities, notes due you)	ESTIMATED VALUE ($)
BUSINESS INTERESTS (sole proprietorship, partnerships, closely held corporation, etc.)	ESTIMATED VALUE ($)
RETIREMENT PLANS (IRA, 401k, etc. †)	ESTIMATED VALUE ($)
VEHICLES (autos, R.V., boat)	ESTIMATED VALUE ($)
PERSONAL PROPERTY (jewelry, furniture, antiques)	ESTIMATED VALUE ($)
TOTAL	ESTIMATED VALUE ($)

* Use best guess; this can be a “ballpark” estimate.

† Do not show benefits which will terminate at death (e.g., pension, social security, etc.). Value of Life Insurance policies will be listed separately on the next page.

“Cash Value” use best estimate (term policies normally have no cash value)
“Face Value” is the amount payable at death

Feedback Matrix Title

	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
1	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
2	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
3	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
4	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY
5	COMPANY	CASH VALUE ($)	FACE VALUE ($)	BENEFICIARY

Peter Robert Stone*
*Also Admitted Colorado

Peter Robert Stone

Attorney & Counselor At Law
A Professional Corporation

P.O. Box 41199
Sacramento, CA 95841
Telephone: 916-348-5600

AGREEMENT FOR

ELECTRONIC MESSAGING

AND STORAGE

I agree*

Client hereby agrees that Attorney shall use electronic mail, cell phone, text messaging, instant messaging, skype or other service, and electronic storage of their files and information. That all communications are agreed to be made in electronic form. By such communication, neither the client nor the attorney waives the attorney-client privilege. Files may be stored electronically in the cloud, the internet, or in the servers owned by law firm. Client understands that there is some risk in allowing the files to be stored and communications to be made electronically. However, there is also risk with physical storage; someone can just walk in and walk out with the file or letters. Client agrees that attorney shall not be liable for anyone hacking client’s email account or attorney’s email account, and that said hacking shall not waive the attorney-client privilege or other privilege. Client agrees that attorney shall not be liable for anyone hacking into the file storage devices. Client agrees to accept any communication electronically to the below addresses as though sent in person or by United States Mail.

Client’s preferred email

Client’s secondary email

Client’s preferred text messaging

Client’s instant message

DATED×

Get Started – Single

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Additional Details

Enter details of children

Enter your EOL Decisions

Signature

Signature

Enter your Burial Wishes

Peter Robert Stone

AGREEMENT FOR

ELECTRONIC MESSAGING

AND STORAGE

Client Signature

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