The Satterwhite Law Firm, PLLC

Estate Planning Client Intake

1605 Fort Hunt Ct • Alexandria, VA 22307 • Trusts & Estates • Real Estate • Business Law

Revocable Living Trust • Pour-Over Will • Powers of Attorney • Advance Medical Directive

1Client Info

2Family

3Assets

4Distribution

5Fiduciaries

6POA / AMD

7Review

Section 01

Client Information

Provide information for the primary client and spouse/partner if applicable.

This intake form is confidential and protected by attorney-client privilege. It does not create an attorney-client relationship until a formal engagement letter is signed.

Primary Client (Grantor 1)

First Name *

Middle Name

Last Name *

Suffix

Date of Birth *

Place of Birth

Email *

Phone *

Street Address *

City

State

ZIP

Citizenship

Marital Status

This is a joint trust — add spouse or partner (Grantor 2)

How Did You Hear About Us?

Notes / Special Circumstances

Section 02

Family & Beneficiaries

Information about your family helps us structure trust distributions and guardianship provisions.

Children

Child 1

First Name

Middle

Last Name

Date of Birth

Relationship

Currently a Minor?

One or more children / beneficiaries are minors (under 18)

Other Beneficiaries

Any other individuals or organizations you intend to include (beyond children).

Special Considerations

A beneficiary has special needs that may affect government benefits eligibility

A beneficiary has substance abuse or financial management concerns

This is a blended family (children from prior relationships)

Additional Family / Beneficiary Notes

Section 03

Assets & Property

An overview of your assets. Estimates are sufficient — exact values are not required at this stage.

Assets must be titled in the name of your trust (or have the trust named as beneficiary) for the trust to govern their disposition. We will advise on retitling during our planning process.

Real Property ▼

Property 1

Property Address

Type

Approx. Value

Mortgage Balance

Financial Accounts (Bank, Brokerage, Investment) ▼

Retirement Accounts (IRA, 401k, 403b, Pension) ▼

Retirement accounts generally should not be titled in trust but may designate the trust or specific individuals as beneficiaries.

Life Insurance ▼

Business Interests ▼

Other Assets (Vehicles, Art, Crypto, Receivables, etc.) ▼

Estimated Estate Value

Approximate Total Estate Value

Prior Estate Planning?

Section 04

Distribution Plan

Describe how you wish your trust assets to be distributed.

During Grantor's Lifetime

Trustee Distribution Standard During Lifetime

Upon Death of First Grantor (Joint Trust Only)

Surviving Spouse / Partner Receives

Upon Death of Last (or Sole) Grantor

Primary Beneficiaries Receive

Equal shares to all surviving children Per stirpes — deceased child's share passes to their descendants Specific percentage allocations (describe below) Other / Custom (describe below)

Describe Distribution Plan

Specific Bequests & Charitable Gifts

Residuary / Ultimate Disposition

If All Named Beneficiaries Predecease — Assets Go To

Alternate / Contingent Beneficiary

Personal Property & Tangible Assets

Distribution of Tangible Personal Property

Notes on Personal Property

Section 05

Fiduciaries

Identify the individuals who will serve as Trustee, Executor, and Guardian.

Trustee

While you are living and competent, you will serve as your own Trustee. The following individuals succeed you upon incapacity or death.

Successor Trustee — Primary *

Relationship to You

City, State

Phone / Email

Alternate Successor Trustee (1st)

Relationship

Alternate Successor Trustee (2nd)

Relationship

Co-Trustees?

Trustee Compensation

Personal Representative (Executor) — Pour-Over Will

Personal Representative — Primary

Relationship

Personal Representative — Alternate

Relationship

Guardian (Minor Children)

Nominate a Guardian for minor children

Section 06

Powers of Attorney & Advance Medical Directive

These documents authorize individuals to act on your behalf during your lifetime if you become incapacitated.

Virginia: Durable General Power of Attorney (Va. Code § 64.2-1600 et seq.); Health Care Decisions Act (Va. Code § 54.1-2981 et seq.). Maryland documents are governed by separate statutes.

Durable General Power of Attorney (Financial)

State(s) Needed

Virginia Maryland Other

Effective Date

Agent (Attorney-in-Fact) — Primary *

Relationship

Alternate Agent (1st)

Relationship

Notes on POA Powers or Limitations

Health Care Power of Attorney & Advance Medical Directive

Health Care Agent — Primary *

Relationship

Alternate Health Care Agent

Relationship

Life-Sustaining Treatment Preferences

Terminal Condition

Withhold or withdraw life-sustaining treatment and allow natural death Continue all life-sustaining treatment Leave decision to my Health Care Agent

Persistent Vegetative State

Withhold or withdraw life-sustaining treatment and allow natural death Continue all life-sustaining treatment Leave decision to my Health Care Agent

Organ & Tissue Donation

Funeral / Burial Preferences

Additional Medical Directive Instructions

HIPAA Authorization

Authorized Individual

Relationship

Section 07

Review & Submit

Review your information before submitting. Use the Back button to correct any section.

Primary Client

Full Name

—

Date of Birth

—

Phone

—

Address

—

Marital Status

—

Key Fiduciaries

Successor Trustee

—

Financial POA Agent

—

Health Care Agent

—

Notes for the Attorney

Anything else we should know before your consultation?

Preferred Consultation Method

In-person Video call Phone

Preferred Days / Times

Acknowledgment: By submitting this intake form, you confirm that the information provided is accurate to the best of your knowledge. This form does not create an attorney-client relationship. Our office will contact you to schedule a consultation and discuss engagement terms.