Legacy Wealth Planning Personal Planning Session Form Δ 1Your Information2Children3Additional Information NameThis field is for validation purposes and should be left unchanged.Your InformationFirst Name(Required)Last Name(Required)Marital Status(Required) Married Unmarried Email Address(Required) Date of Birth(Required) Client GenderFemaleMaleOccupationEmployerAre you a U.S. Citizen?(Required) Yes No Spouse/Partner InformationSpouse/Partner’s First NameSpouse/Partner’s Last NameSpouse/Partner's Email Address Spouse/Partner’s DOB Spouse GenderMaleFemaleSpouse/Partner's OccupationSpouse/Partner's EmployerAre you a U.S. Citizen?(Required) Yes No Physical AddressPhysical Address Line 1Physical Address Line 2Physical Address CityUntitledPhysical Address ZipIs your Mailing Address the same as Physical Address? My Mailing Address is the same My Mailing Address is different. I’d like to enter that address Mailing AddressMailing Address Line 1Mailing Address Line 2Mailing Address CityMailing Address State Mailing StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Mailing Address ZipPhone Number 1Phone Number 1 DescriptionSelect…HomeMobileMobile (Spouse)OtherPhone 1 numberAdd A Second Number Add Another Phone Number Phone Number 2Phone Number 2 DescriptionSelect…HomeMobileMobile (Spouse)OtherPhone 2 numberAdd A Third Number Add Another Phone Number Phone Number 3Phone Number 3 DescriptionSelect…HomeMobileMobile (Spouse)OtherPhone 3 number How many children do you have, living or deceased?01234More than 4If you have more than 4 children let us know during the personal consultation. This field is hidden when viewing the formSection BreakChild 1Child 1 First NameChild 1 Last NameChild 1 Date of Birth Child 1 GenderChild 1's GenderMaleFemaleChild 1's Parent(s)Child 1's Parent(s)BothYouSpouseIs Child 1 Married? Yes No Does Child 1 Have Children? Yes No Child 2Child 2 First NameChild 2 Last NameChild 2 Date of Birth Child 2 GenderChild 2's GenderMaleFemaleChild 2's Parent(s)Child 2's Parent(s)BothYouSpouseIs Child 2 Married? Yes No Does Child 2 Have Children? Yes No Child 3Child 3 First NameChild 3 Last NameChild 3 Date of Birth Child 3 GenderSelect GenderMaleFemaleChild 3's Parent(s)Child 3's Parent(s)BothYouSpouseIs Child 3 Married? Yes No Does Child 3 Have Children? Yes No Child 4Child 4 First NameChild 4 Last NameChild 4 Date of Birth Child 4 GenderSelect GenderMaleFemaleChild 4's Parent(s)Child 4's Parent(s)BothYouSpouseIs Child 4 Married? Yes No Does Child 4 Have Children? Yes No Additional Children InformationEnter Additional Children Information My estate has the following assets: Real Estate Bank Accounts Stocks, Bonds, Mutual Funds IRA/Retirements Plans Life Insurance/Annuities Business/Partnerships Certificates of Deposit Safe Deposit Box Do you currently have a Will or Living Trust?(Required) Yes No Please check one of the following boxes:(Required) I am ready to proceed with the creation of my 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: Enter Additional QuestionsApproximate gross value of my estate(Required)When estimating the gross value of your estate, include the current fair market value of your home or any other real estate.Select…$0-$200,000$200,001-$1 million$1 million-$5 million$5 million-$15 millionOver $15 millionI have concerns about a Special Needs family member: Yes No What Really Matters to MePlease review the following items and check the boxes that hold the highest importance for you. Make sure there’s a written plan to handle my affairs Exercise my right to make my own decisions about what happens to my assets (avoid probate!) Minimize all death taxes After my death, make sure my estate stays with my children if they get divorced After my death, protect my estate from my children’s creditors After my death, protect my estate if my spouse gets remarried Make sure my wishes are honored regarding life support decisions Ensure I don’t leave an expensive, chaotic mess for my loved ones. Texting Permission I agree to receive texts at the number provided from Bier Law. Frequency may vary and include information on appointments, events, and other marketing messages. Message/data rates may apply. To opt-out, text STOP at any time. Disclaimer: No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
