Estate Planning Intake | Joseph A. McMillen, Attorney at Law

Your Personal Information

First Name *

Middle Name

Last Name *

Date of Birth *

Phone *

Email *

Home Address (Street, City, State, ZIP, County) *

Marital Status

Spouse / Partner Full Legal Name (if applicable)

Spouse Date of Birth

Spouse Phone / Email

Prior marriages or divorces? Please briefly describe

Estate Planning Goals — Documents Desired

Select all documents you are interested in. Joe will advise on what makes sense for your situation during the consultation.

Which documents are you interested in?

Last Will & Testament Durable Power of Attorney (Financial) Healthcare Power of Attorney Revocable Living Trust Living Will / Advance Directive Probate / Estate Administration Not sure — I need guidance

What is prompting you to seek estate planning now? (optional)

Do you have any existing estate planning documents (will, trust, POA)?

Yes No

Children & Family Structure

Do you have children?

Yes No

List all children (name, date of birth, relationship — biological / adopted / stepchild)

Are any children minors (under 18)?

Yes No N/A — no children

If you have minor children — who would you name as Guardian if something happened to you?

Are there any children with special needs, disabilities, or unique circumstances?

Any other family members who depend on you financially?

Assets & Property Overview

Approximate values are fine. We don't need exact figures at this stage — just a general sense of what you own so Joe can recommend the right planning approach.

Real Estate (address / approximate value / how titled — sole, joint, etc.)

Vehicles (year / make / titled to)

Bank & investment accounts (approximate total value / how titled)

Retirement accounts (type / whose name / approximate value)

Life insurance policies (company / face amount / current beneficiary)

Business interests (business name / type / approximate value / your ownership %)

Other significant assets (farm land, collectibles, inheritance expected, etc.)

Significant debts (mortgage, loans — approximate total)

Beneficiaries & Distribution Wishes

Who do you want to receive your assets? List primary beneficiaries below. Joe will help you think through contingencies during the consultation.

Primary Beneficiary 1

Full Name

Relationship

Share / Amount

Primary Beneficiary 2

Full Name

Relationship

Share / Amount

Primary Beneficiary 3 (if applicable)

Full Name

Relationship

Share / Amount

Alternate / Contingent Beneficiary (if primary does not survive you)

Are there any family members or individuals you specifically wish to exclude from your estate?

Any charitable gifts or bequests you'd like to make?

Personal Representative, Trustee & Agent Designations

These are the people you trust to carry out your wishes if you pass away or become incapacitated. They do not need to be attorneys or financial experts — just trustworthy and organized.

Personal Representative / Executor (first choice)
Person to manage your estate after death

Personal Representative / Executor (backup)

Trustee (first choice) — if you want a living trust
Person to manage trust assets

Trustee (backup)

Financial Power of Attorney Agent (first choice)
Person to manage finances if you are incapacitated

Financial POA Agent (backup)

Healthcare Power of Attorney Agent (first choice)
Person to make medical decisions if you cannot

Healthcare POA Agent (backup)

Healthcare Wishes & Advance Directives

If you were in a terminal condition with no reasonable expectation of recovery, do you wish for life-prolonging treatment to continue?

Yes — continue all treatment No — comfort care only I want to discuss this with Joe

Any specific healthcare wishes or values Joe should know about?

Special Circumstances & Additional Information

Any blended family issues, prior divorce, or child support obligations Joe should be aware of?

Any concerns about a beneficiary's ability to manage money (addiction, disability, creditor issues, etc.)?

Is there anything you own jointly that may need to be addressed (real estate, accounts, vehicles)?

Any other information, wishes, or questions you'd like to discuss with Joe?

Certification & Submission

By typing your name below and clicking Submit, you certify that the information provided is true and correct to the best of your knowledge. This form does not create an attorney-client relationship.

I certify that the information provided in this intake form is true and correct to the best of my knowledge and I understand it will be shared with Joe McMillen, Attorney at Law, and his staff in confidence.

Electronic Signature (type your full legal name) *

Today's Date *

⚠ Your information will be sent securely to Joe McMillen (joe@bolivarlawoffice.com) and Tiffany Rowell (tiffany@bolivarlawoffice.com). This form does not create an attorney-client relationship. If you have urgent matters, please call (417) 298-9661 directly.

✓ Estate Planning Intake Submitted

Thank you. Your intake has been sent to Joe and Tiffany. They will be in touch within one business day to schedule your consultation. If you have a time-sensitive matter, please call (417) 298-9661.

Estate Planning IntakeWills, Trusts & Powers of Attorney

Your Personal Information

Estate Planning Goals — Documents Desired

Children & Family Structure

Assets & Property Overview

Beneficiaries & Distribution Wishes

Primary Beneficiary 1

Primary Beneficiary 2

Primary Beneficiary 3 (if applicable)

Personal Representative, Trustee & Agent Designations

Healthcare Wishes & Advance Directives

Special Circumstances & Additional Information

Certification & Submission

✓ Estate Planning Intake Submitted

Estate Planning Intake
Wills, Trusts & Powers of Attorney