T&WO Aging Parents Intake Form – Silver

Your Name*

Are you married?*

Yes
No

Spouse's Name*

Email*

Phone*

Address*

Street Address City State ZIP Code

Do you own or rent?*

Own
Rent

How many children do you have?*

1st Child's Name*

Age*

2nd Child's Name*

Age*

3rd Child's Name*

Age*

4th Child's Name*

Age*

5th Child's Name*

Age*

6th Child's Name*

Age*

7th Child's Name*

Age*

8th Child's Name*

Age*

9th Child's Name*

Age*

10th Child's Name*

Age*

Who would be the guardian if both parents are deceased?

Guardian's Name

Backup Guardian's Name

Is there a child with special needs or that is on Medi-Cal or SSI?*

Yes
No

Please specify any specific gifts you want to give people and write their full name next to the item

How would you like to distribute the estate? Please specify a % or fraction and the full name of the person the portion will be distributed to.*

Who would be in charge of finances for if you became incapacitated or deceased?

Name

Backup Person's Name

Who would be in charge of health choices if you became incapacitated or deceased?

Name

Backup Person's Name

Do you own other parcels of real property other than your primary residence?*

Yes
No

Please list the addresses of your properties.*

Please list your assets and their approximate value.*

Aging Parents Package

Price:

Add Spouse

Price:

Coupon

Total

$0.00

Consent*

I agree to the privacy policy.

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CONTACTING Trusts and Wills Online:
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Credit Card*

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Set Up an Aging Parents Package

Who would be the guardian if both parents are deceased?

Who would be in charge of finances for if you became incapacitated or deceased?

Who would be in charge of health choices if you became incapacitated or deceased?

357 Cliffwood Park St. Suite B, Brea CA 92821

714-350-9255

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