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BrookHaven Integrated Wealth Strategies
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Legal Intake

Please fill out the form below to submit information that we will use to draft your legal documents.

Legal Intake Questionnaire

Preview of our secure intake — online submission is launching soon.

Preview

Your Information

Name *
First
Middle
Last
Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Is the address listed above also where you can receive mail? *Options: Yes, No
Mailing Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Email *
Phone *
Date of Birth *
Sex *Options: Male, Female, Other
Are you a U.S. citizen *Options: Yes, No
Are you a citizen of any other country? *Options: No, Yes
Which country are you a citizen of? *
Do you currently receive any government benefits? (i.e., Medicaid, Supplemental Security Income, Social Security Disability Insurance, Etc.) *Options: Yes, No
Please provide details *
Marital Status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
Will your spouse have any ownership interest in the business? *Options: Yes, No
Do you have a medical diagnosis regarding mental capacity to execute legal documents? (i.e., dementia, Alzheimer’s, etc.) *Options: Yes, No
Are you legally blind? *Options: Yes, No
Are you disabled? *Options: Yes, No
Please provide information to the degree you are comfortable providing. *
Which most accurately describes your health condition? *Options: Excellent, Reasonably Good, Poor, Serious Adverse Condition
Do you use any form of tobacco? *Options: Yes, No
Do you have life insurance? *Options: Yes, No
Please provide a detail as to how much and type (term/permanent). *
Do you have an umbrella insurance policy in place? *Options: Yes, No
Do you have an individual retirement account (IRA)? *Options: Yes, No
Do you have access to a 401(k) through your employer? *Options: Yes, No
Do you have a 401(k) from a previous employer that you no longer contribute to? *Options: Yes, No
Do you have any other retirement accounts not listed above (i.e., SEP, 403(b), FERS, pensions, etc.)? *Options: Yes, No
Please list other retirement accounts here: *
When do you plan on retiring? *Options: Already retired, 1-5 years, 5-10 years, 11-15 years, 16-20 years, 21-30 years, 30+ years
Total Net Worth (combined if married/partnership) *
Annual Income *

Spouse Information

Spouse or Partner Name *
First
Middle
Last
Spouse/Partner's address (If different from your address) *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Is Spouse/Partner's mailing address different from the address above? *Options: Yes, No
Spouse/Partner's Mailing Address (if different from your mailing address) *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Spouse/Partner's Email *
Spouse/Partner's Phone *
Spouse/Partner's Date of Birth *
Is Spouse/Partner a U.S. Citizen? *Options: Yes, No
Is Spouse/Partner a citizen of any other country?Options: No, Yes
Please list which country/countries Spouse/Partner is a citizen of. *
Does Spouse/Partner currently receive any government benefits? (i.e., Medicaid, Supplemental Security Income, Social Security Disability Insurance, Etc.) *Options: Yes, No
Please provide details. *
Does Spouse/Partner have a medical diagnosis regarding mental capacity to execute legal documents? (i.e., dementia, Alzheimer’s, etc.) *Options: Yes, No
Is Spouse/Partner legally blind? *Options: Yes, No
Is Spouse/Partner disabled? *Options: Yes, No
Please provide information to the degree you are comfortable providing. *
Which most accurately describes Spouse/Partner's health condition? *Options: Excellent, Reasonably Good, Poor, Serious Adverse Condition
Does Spouse/Partner use any form of tobacco? *Options: Yes, No
Does Spouse/Partner have life insurance? *Options: Yes, No
Please provide a detail as to how much and type (term/permanent) *
Does Spouse/Partner have an umbrella insurance policy in place? *Options: Yes, No
Does Spouse/Partner have an individual retirement account (IRA)? *Options: Yes, No
Does Spouse/Partner have access to a 401(k) through your employer? *Options: Yes, No
Does Spouse/Partner have a 401(k) from a previous employer that you no longer contribute to? *Options: Yes, No
Does Spouse/Partner have any other retirement accounts not listed above (i.e., SEP, 403(b), FERS, pensions, etc.)? *Options: Yes, No
Please list the types of retirement accounts Spouse/Partner has that aren’t listed above *
When does Spouse/Partner plan on retiring? *Options: Already retired, 1-5 years, 5-10 years, 11-15 years, 16-20 years, 21-30 years, 30+ years
Spouse/Partner's annual income *

Current Plan

Last Will & TestamentOptions: Yes
Last Will & Testament File Upload
Revocable Living TrustOptions: Yes
Revocable Living Trust File Upload
Irrevocable TrustOptions: Yes
Irrevocable Trust File Upload

Children

Do you have children? *Options: Yes, No
How many children do you and your spouse/partner have (including biological children, adopted children, and step children)? *Options: 1, 2, 3, 4, 5, 6

First Child Information

1. Child’s Full Name *
First
Middle
Last
1. Child’s Date of Birth *
1. Child’s Gender *Options: Male, Female
1. Is the child legally blind? *Options: Yes, No
1. Is the child disabled? *Options: Yes, No
1. Please provide detail below *
1. Is the child receiving SSI benefits? *Options: Yes, No
1. Relationship to child (biological child, adopted, stepchild, other) *
1. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
1. Is the child a minor? *Options: Yes, No
1. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
1. Spouse/Partner’s name *
First
Last

Second Child Information

2. Child’s Full Name *
First
Middle
Last
2. Child’s Date of Birth *
2. Child’s Gender *Options: Male, Female
2. Is the child legally blind? *Options: Yes, No
2. Is the child disabled? *Options: Yes, No
2. Please provide detail below *
2. Is the child receiving SSI benefits? *Options: Yes, No
2. Relationship to child (biological child, adopted, stepchild, other) *
2. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
2. Is the child a minor? *Options: Yes, No
2. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
2. Spouse/Partner’s name *
First
Last

Third Child Information

3. Child’s Full Name *
First
Middle
Last
3. Child’s Date of Birth *
3. Child’s Gender *Options: Male, Female
3. Is the child legally blind? *Options: Yes, No
3. Is the child disabled? *Options: Yes, No
3. Please provide detail below *
3. Is the child receiving SSI benefits? *Options: Yes, No
3. Relationship to child (biological child, adopted, stepchild, other) *
3. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
3. Is the child a minor? *Options: Yes, No
3. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
3. Spouse/Partner’s name *
First
Last

Fourth Child Information

4. Child’s Full Name *
First
Middle
Last
4. Child’s Date of Birth *
4. Child’s Gender *Options: Male, Female
4. Is the child legally blind? *Options: Yes, No
4. Is the child disabled? *Options: Yes, No
4. Please provide detail below *
4. Is the child receiving SSI benefits? *Options: Yes, No
4. Relationship to child (biological child, adopted, stepchild, other) *
4. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
4. Is the child a minor? *Options: Yes, No
4. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
4. Spouse/Partner’s name *
First
Last

Fifth Child Information

5. Child’s Full Name *
First
Middle
Last
5. Child’s Date of Birth *
5. Child’s Gender *Options: Male, Female
5. Is the child legally blind? *Options: Yes, No
5. Is the child disabled? *Options: Yes, No
5. Please provide detail below *
5. Is the child receiving SSI benefits? *Options: Yes, No
5. Relationship to child (biological child, adopted, stepchild, other) *
5. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
5. Is the child a minor? *Options: Yes, No
5. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
5. Spouse/Partner’s name *
First
Last

Sixth Child Information

6. Child’s Full Name *
First
Middle
Last
6. Child’s Date of Birth *
6. Child’s Gender *Options: Male, Female
6. Is the child legally blind? *Options: Yes, No
6. Is the child disabled? *Options: Yes, No
6. Please provide detail below *
6. Is the child receiving SSI benefits? *Options: Yes, No
6. Relationship to child (biological child, adopted, stepchild, other) *
6. Spouse’s/partner’s relationship to child *Options: biological child, adopted, stepchild, other
6. Is the child a minor? *Options: Yes, No
6. Child’s marital status *Options: Single, Married, Divorced, Widowed, Legally Separated, Registered Domestic Long-Term Partnership
6. Spouse/Partner’s name *
First
Last

Grandchildren

Do you have any grandchildren? *Options: Yes, No
Do you wish to discuss the options for disinheritance, limitation of inheritance, or other specific restrictions regarding any of your grandchildren? *Options: Yes, No
How many grandchildren do you and your spouse/partner have? *Options: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

First Grandchild

1. Grandchild’s Full Name *
First
Middle
Last
1. Father of grandchild *
First
Middle
Last
1. Mother of grandchild *
First
Middle
Last
1. Grandchild’s Date of Birth
1. Gender *Options: Male, Female
1. Is this grandchild legally blind? *Options: Yes, No
1. Is this grandchild disabled? *Options: Yes, No
1. Please provide detail below. *
1. Is this grandchild receiving SSI benefits? *Options: Yes, No

Second Grandchild

2. Grandchild’s Full Name *
First
Middle
Last
2. Father of grandchild *
First
Middle
Last
2. Mother of grandchild *
First
Middle
Last
2. Grandchild’s Date of Birth *
2. Gender *Options: Male, Female
2. Is this grandchild legally blind? *Options: Yes, No
2. Is this grandchild disabled? *Options: Yes, No
2. Please provide detail below. *
2. Is this grandchild receiving SSI benefits? *Options: Yes, No

Third Grandchild

3. Grandchild’s Full Name *
First
Middle
Last
3. Father of grandchild *
First
Middle
Last
3. Mother of grandchild *
First
Middle
Last
3. Grandchild’s Date of Birth *
3. Gender *Options: Male, Female
3. Is this grandchild legally blind? *Options: Yes, No
3. Is this grandchild disabled? *Options: Yes, No
3. Please provide detail below. *
3. Is this grandchild receiving SSI benefits? *Options: Yes, No

Fourth Grandchild

4. Grandchild’s Full Name *
First
Middle
Last
4. Father of grandchild *
First
Middle
Last
4. Mother of grandchild *
First
Middle
Last
4. Grandchild’s Date of Birth *
4. Gender *Options: Male, Female
4. Is this grandchild legally blind? *Options: Yes, No
4. Is this grandchild disabled? *Options: Yes, No
4. Please provide detail below. *
4. Is this grandchild receiving SSI benefits? *Options: Yes, No

Fifth Grandchild

5. Grandchild’s Full Name *
First
Middle
Last
5. Father of grandchild *
First
Middle
Last
5. Mother of grandchild *
First
Middle
Last
5. Grandchild’s Date of Birth *
5. Gender *Options: Male, Female
5. Is this grandchild legally blind? *Options: Yes, No
5. Is this grandchild disabled? *Options: Yes, No
5. Please provide detail below. *
5. Is this grandchild receiving SSI benefits? *Options: Yes, No

Sixth Grandchild

6. Grandchild’s Full Name *
First
Middle
Last
6. Father of grandchild *
First
Middle
Last
6. Mother of grandchild *
First
Middle
Last
6. Grandchild’s Date of Birth *
6. Gender *Options: Male, Female
6. Is this grandchild legally blind? *Options: Yes, No
6. Is this grandchild disabled? *Options: Yes, No
6. Please provide detail below. *
6. Is this grandchild receiving SSI benefits? *Options: Yes, No

Seventh Grandchild

7. Grandchild’s Full Name *
First
Middle
Last
7. Father of grandchild *
First
Middle
Last
7. Mother of grandchild *
First
Middle
Last
7. Grandchild’s Date of Birth *
7. Gender *Options: Male, Female
7. Is this grandchild legally blind? *Options: Yes, No
7. Is this grandchild disabled? *Options: Yes, No
7. Please provide detail below. *
7. Is this grandchild receiving SSI benefits? *Options: Yes, No

Eighth Grandchild

8. Grandchild’s Full Name *
First
Middle
Last
8. Father of grandchild *
First
Middle
Last
8. Mother of grandchild *
First
Middle
Last
8. Grandchild’s Date of Birth *
8. Gender *Options: Male, Female
8. Is this grandchild legally blind? *Options: Yes, No
8. Is this grandchild disabled? *Options: Yes, No
8. Please provide detail below. *
8. Is this grandchild receiving SSI benefits? *Options: Yes, No

Ninth Grandchild

9. Grandchild’s Full Name *
First
Middle
Last
9. Father of grandchild *
First
Middle
Last
9. Mother of grandchild *
First
Middle
Last
9. Grandchild’s Date of Birth *
9. Gender *Options: Male, Female
9. Is this grandchild legally blind? *Options: Yes, No
9. Is this grandchild disabled? *Options: Yes, No
9. Please provide detail below. *
9. Is this grandchild receiving SSI benefits? *Options: Yes, No

Tenth Grandchild

10. Grandchild’s Full Name *
First
Middle
Last
10. Father of grandchild *
First
Middle
Last
10. Mother of grandchild *
First
Middle
Last
10. Grandchild’s Date of Birth *
10. Gender *Options: Male, Female
10. Is this grandchild legally blind? *Options: Yes, No
10. Is this grandchild disabled? *Options: Yes, No
10. Please provide detail below. *
10. Is this grandchild receiving SSI benefits? *Options: Yes, No

Core Estate Planning

Important Relationships. This first section is going to ask you to provide detail relating to who will fill critical roles upon your death or mental incapacitation. We will cover: Executorship Health care agents (medical decision) Primary agents (financial decisions) Guardianship (in the event you have a minor child)

Executors

This section pertains to the individuals who will serve as executor and handle the administration of your estate upon your death.

Initial Executor *Options: Spouse/Partner, Other
If “Other” – *
Name
Relationship
Address

Successor Executors

This section pertains to the individuals who will serve as executor upon the death/disability of the initial executor.

List in Order of Succession *This section pertains to the individuals who will serve as executor upon the death/disability of the initial executor.
Name
Relationship
Address
Primary Health Care Agent(s) *(Will serve concurrently if more than one listed) A health care agent is someone you choose to make medical decisions on your behalf if you’re unable to make them yourself due to being legally incompetent.
Name
Relationship
Address
Successor Primary Health Care Agent(s) *This section pertains to the individuals who will serve as your primary health care agent(s) upon the death/disability of those initially appointed.
Name
Relationship
Address
Successor Primary Health Care Agent(s) *This section pertains to the individuals who will serve as your primary health care agent(s) upon the death/disability of those initially appointed.
Name
Relationship
Address
Power of Attorney - Primary Agent(s) *This section pertains to the appointment of an individual to act as your Power of Attorney in terms of legal decision-making authority on your behalf in the event of your incapacitation.
Name
Relationship
Address
Successor Primary Agent(s) *This section pertains to the individuals who will serve as your primary agent(s) upon the death/disability of those initially appointed.
Name
Relationship
Address
Initial Guardian *This section pertains to the appointment of an individual to act as guardian of your minor children in the event of your incapacitation.
Name
Relationship
Address
Successor Guardian *This section pertains to the individuals who will serve as guardian upon the death/disability of those initially appointed.
Name
Relationship
Address
If any child has another biological parent with custody, please indicate custody arrangements here so we can take those into consideration for guardianship purposes: *
Do you want to provide for continued nutrition/hydration (food/water) if your death was imminent? *Options: Yes, No
Do you wish to become an organ donor? *Options: Yes, No
Do you have a preferred hospital? *Options: Yes, No
Please list name and address below. *
Do you have a primary care physician? *Options: Yes, No
Please list name, hospital (if applicable), and address below. *
Do you have any animals or pets that will need caring for after you pass away? *Options: Yes, No
Please offer any guidance you wish to include in your plan as to how your pets or animals should be cared for and by whom. *
Have you and/or your spouse/partner ever filed a Federal Gift Tax Return? *Options: Yes, No
Are there any prior tax year(s) in which you did NOT file a tax return? *Options: Yes, No
For which years did you NOT file a tax return? *

Other Assets Inventory

Do you (or your spouse, if applicable) currently own or rent your primary residence? *Options: Yes, No
Do you (or your spouse, if applicable) currently own or rent any other real property? (i.e., investment properties, vacation properties, etc.) *Options: Yes, No
Do you (or your spouse, if applicable) own a farm or ranch? *Options: Yes, No
Do you (or your spouse, if applicable) own any interest in a Medical, Dental, or Veterinarian Practice? *Options: Yes, No
Do you (or your spouse, if applicable) own stock in a Subchapter S Corporation? *Options: Yes, No
Do you (or your spouse, if applicable) own interests in gas/oil? *Options: Yes, No
Do you (or your spouse, if applicable) currently own a business? *Options: Yes, No
If you (or your spouse, if applicable) currently own a business, please provide details, including type of business (LLC, Corporation, etc.), nature of business, names of other owners/interested parties, and income information. *
Do you (or your spouse, if applicable) have a safe-deposit box? *Options: Yes, No
Please provide the name of the bank and address below. *
Please indicate the location of any important papers that your executors, agents, or beneficiaries should be aware of *

Dispositive Provisions

This section provides for specific gifts/devises you may choose to leave to specific beneficiaries (children, grandchildren, other family members, friends, etc.). Please include specific instructions you would like the trust to reflect about each provision (i.e., Set aside certain amount for college fund, not to be accessed until age of majority; Amount payable each month for remainder of beneficiary life, i.e., Antique cabinet and all of its contents to said beneficiary)

Cash Gifts (cash and cash-equivalent gifts) *
Name of Recipient
Relationship
Owner (you or spouse/partner)
Amount & Location (bank, safe, etc.)
Gifts of Real Estate *
Name of Recipient
Relationship
Owner (you or spouse/partner)
Amount & Location (bank, safe, etc.)
Gifts of Tangible Property (automobiles/jewelry/art/etc.) *
Name of Recipient
Relationship
Owner (you or spouse/partner)
Amount & Location (bank, safe, etc.)
Gifts of Intangibles (stock/bonds/annuities/etc.) *
Name of Recipient
Relationship
Owner (you or spouse/partner)
Amount & Location (bank, safe, etc.)

Trust Protector

Once the Trustors (you and your spouse/partner) have passed away, the Trust Protector acts on behalf of the Trustors and monitors the Trustee’s adherence to the trust. They can hire and fire trustees and review any account information and trust documents to ensure the administration of the trust is going in accordance with the wishes of the Trustors. Typically, trust protectors are family members or trusted friends of the individual(s) establishing the trust. You are NOT required to appoint a Trust Protector. If you desire, you can appoint an Trust Protector later as long as you are not incapacitated.

Would you like to appoint a trust protector to serve upon your incapacitation? *Options: Yes, No
Initial Trust Protector *
Name
Relationship
Address
Successor Trust Protector(s) (will serve upon death/disability of Initial Trust Protector) *List in Order of Succession
Name
Relationship
Address

Investment Advisor

The Investment Advisor acts as a financial advisor to the trust and assists the trustee with strategic investment and money management to ensure the assets of the trust are growing and being invested wisely. You are NOT required to appoint an Investment Advisor. If you desire, you can appoint an investment advisor later as long as you are not incapacitated.

Would you like to appoint an investment advisor to serve upon your incapacitation? *Options: Yes, No
Initial Investment Advisor *
Name
Relationship
Address
Successor Investment Advisor(s) (will serve upon death/disability of Initial Trust Protector) *List in Order of Succession
Name
Relationship
Address

Beneficiaries

When creating a trust, you must name beneficiaries. By default, if you are married, your trust will be drafted to care for you and your spouse/partner while you are living and then flow down to your child(ren) once you both have passed away. If you are unmarried or have no children, your trust will be drafted so that if you become married and/or have children, they will automatically become your beneficiaries, but you will still need to name beneficiaries to inherit your estate otherwise.

Please provide a thorough description of your wishes as to how you wish to see your estate disbursed, including any specific inheritance considerations you would like our team to consider in drafting your estate plan (i.e., everything split evenly among children; disinherit a child; leave certain amounts to charity; etc.) *
Beneficiaries *
Name
Relationship
Address
Which of the following statements is aligned more with your estate planning goals: *
I desire a generationally focused trust. After my passing and the passing of my spouse/partner (if applicable), I intend for this trust to benefit my named beneficiaries, but to be managed in a way that is generationally focused and will later benefit the descendants of my beneficiaries.
I desire a trust that is built around the lifetime of my immediate beneficiaries. After my passing and the passing of my spouse/partner (if applicable), I intend for this trust to benefit my named beneficiaries. My trustee shall be less concerned with managing the trust to last for multiple generations, thereby allowing more to be distributed to my beneficiaries over the course of their lives.

Asset Protection Trust

When creating a trust, you must name beneficiaries. By default, if you are married, your trust will be drafted to care for you and your spouse/partner while you are living, and then flow down to your child(ren) once you both have passed away. If you are unmarried or you have no children, your trust will be drafted so that if you become married and/or have children, they will automatically become your beneficiaries, but you will still need to name beneficiaries to inherit your estate otherwise. Please note: This trust is irrevocable and cannot be changed, and it requires an attorney/qualified trustee to serve as trustee, and you would have to contact the trustee to access your funds within the trust. The benefits of this trust include asset protection from creditors and potential litigants, and providing a level of separation between you and the assets in the trust.

Please provide a thorough description of your wishes as to how you wish to see your estate disbursed *
Generational Trust Provision: Please select which statement is the most accurate. *
After my passing, I desire a generational trust that will care for my spouse, my children and descendants, and their descendants for decades to come. (This means the trustee would be more restrictive and focused on preserving the trust to provide for generations to come).
After my passing, I desire a trust that will care for my spouse and my children, distributing entirely over the course of those beneficiaries’ lives. (This means the trustee would be more lenient with distributions for your children/named beneficiaries, because the trust would be distributed during their lifetime and does not need to last for generations to come).

Trustee Selection

Some trusts require an attorney/qualified trustee to serve as trustee, while others do not. If you do NOT wish to have Brookhaven serve as trustee, please ensure the person you appoint is qualified as required by relevant statutory law, including location of individual or entity, and eligibility as an attorney, trust company, or other qualified entity or individual.

Do you wish to have Brookhaven serve as trustee? *
Yes
No
Trustee Name *
Trustee Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code

Trust Protector

Once the Trustors (you and your spouse/partner) have passed away, the Trust Protector acts on behalf of the Trustors and monitors the Trustee’s adherence to the trust. They can hire and fire trustees and review any account information and trust documents to ensure the administration of the trust is going in accordance with the wishes of the Trustors. Typically, trust protectors are family members or trusted friends of the individual(s) establishing the trust. You are NOT required to appoint a Trust Protector. If you desire, you can appoint an Trust Protector later as long as you are not incapacitated.

Would you like to appoint a trust protector to serve upon your incapacitation? *Options: Yes, No
Initial Trust Protector *
Name
Relationship
Address
Successor Trust Protector(s) (will serve upon death/disability of Initial Trust Protector) *List in Order of Succession
Name
Relationship
Address

Investment Advisor

The Investment Advisor acts as a financial advisor to the trust and assists the trustee with strategic investment and money management to ensure the assets of the trust are growing and being invested wisely. You are NOT required to appoint an Investment Advisor. If you desire, you can appoint an investment advisor later as long as you are not incapacitated.

Would you like to appoint an investment advisor to serve upon your incapacitation? *Options: Yes, No
Initial Investment Advisor *
Name
Relationship
Address
Successor Investment Advisor(s) (will serve upon death/disability of Initial Trust Protector) *List in Order of Succession
Name
Relationship
Address

Beneficiaries

When creating a trust, you must name beneficiaries. By default, if you are married, your trust will be drafted to care for you and your spouse/partner while you are living and then flow down to your child(ren) once you both have passed away. If you are unmarried or have no children, your trust will be drafted so that if you become married and/or have children, they will automatically become your beneficiaries, but you will still need to name beneficiaries to inherit your estate otherwise. Please provide a thorough description of your wishes as to how you wish to see your estate disbursed, including any specific inheritance considerations you would like our team to consider in drafting your estate plan (i.e., everything split evenly among children; disinherit a child; leave certain amounts to charity; etc.)

Beneficiaries *Trust Distributions After Your Passing
Name
Relationship
Address
Which of the following statements is aligned more with your estate planning goals: *
I desire a generationally focused trust. After my passing and the passing of my spouse/partner (if applicable), I intend for this trust to benefit my named beneficiaries, but to be managed in a way that is generationally focused and will later benefit the descendants of my beneficiaries.
I desire a trust that is built around the lifetime of my immediate beneficiaries. After my passing and the passing of my spouse/partner (if applicable), I intend for this trust to benefit my named beneficiaries. My trustee shall be less concerned with managing the trust to last for multiple generations, thereby allowing more to be distributed to my beneficiaries over the course of their lives.

Charitable Beneficiaries

The named charitable beneficiaries will be the recipients of what is left within trust at the end of its term. You may name as many charitable beneficiaries as you like so long as each is a registered 501(c)(3) organization.

Charitable Beneficiaries *
Non-Profit Organization
Percentage of Remainder
Address
How long would you like the trust to last? *Options: I want a trust that benefits me (and my spouse/partner if applicable) for life before it benefits a charity., I want a trust that exists for a term of years (up to 20 years), and after the term of years I would like the remainder of the trust to pour over into one or more non-profits.
How many years? (maximum of 20 years) *
How frequently should the income recipients receive payment? *Options: Monthly, Quarterly, Semi-Annually, Annually
On what month and year do you intend to fund the trust (i.e., contribute property to the trust)? *
What amount do you expect to fund within the trust initially? *

Irrevocable Life Insurance Trust

Some trusts require an attorney/qualified trustee to serve as trustee, while others do not. If you do NOT wish to have Brookhaven serve as trustee, please ensure the person you appoint is qualified as required by relevant statutory law, including location of individual or entity, and eligibility as an attorney, trust company, or other qualified entity or individual.

Do you wish to have Brookhaven serve as trustee? *
Yes
No
Trustee Name *
Trustee Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Successor TrusteesList in Order of Succession
Name
Relationship
Address

Investment Adviser

The Investment Advisor acts as a financial advisor to the trust and assists the trustee with strategic investment and money management to ensure the assets of the trust are growing and being invested wisely. You are NOT required to appoint an Investment Advisor. If you desire, you can appoint an investment adviser later as long as you are not incapacitated.

Do you wish to have Brookhaven serve as the investment advisor? *
Yes
No
Investment Advisor Name *
Investment Advisor Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code

Trust Protector

Once the Trustors (you and your spouse/partner) have passed away, the Trust Protector acts on behalf of the Trustors and monitors the Trustee’s adherence to the trust. They can hire and fire trustees and review any account information and trust documents to ensure the administration of the trust is going in accordance with the wishes of the Trustors. Typically, trust protectors are family members or trusted friends of the individual(s) establishing the trust. You are NOT required to appoint a Trust Protector. If you desire, you can appoint an Trust Protector later as long as you are not incapacitated.

Would you like to appoint a trust protector to serve upon your incapacitation? *Options: Yes, No
Initial Trust Protector *
Name
Relationship
Address
Successor Trust Protector(s) (will serve upon death/disability of Initial Trust Protector) *List in Order of Succession
Name
Relationship
Address

Policy Information

Please provide the information for the life insurance policy(ies) you intend to place in this trust *
Policy Name
Policy Number
Effective Date
Death Benefit
Insured Name
Plan Type

Beneficiaries

Please list your beneficiary information *

Governance Documents

You attorney will draft governance documents to set up your LLC. The company will be structured in Wyoming, and the attorney will handle the Secretary of State filing, FinCEN filing requirements, and obtain the EIN. All of this will be provided to you along with the Operating Agreement.

Desired Company Name

Provide the full company name EXACTLY how you want it to be filed, along with two alternative company names in the event your desired company name is not available with the Secretary of State.

Desired Company Name: First Choice *
Desired Company Name: Second Choice *
Desired Company Name: Third Choice *
Business Purpose
Principal Place of Business (must be a physical address) *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
I am my own registered agent (must live in state) *
Yes
No
Do you want your attorney to suggest a WY Registered Agent Company as the registered agent/mailing address? *
Yes
No
Registered Agent Address (must be a physical address IN WYOMING) *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code

Responsible Party

All entities are required to have an individual listed as the Responsible Party. This person will be listed as the Organizer with the Secretary of State, will be listed as the Beneficial Owner for FinCEN compliance, and will be the named individual on all tax documents.

Responsible Party's Name *
First
Last
Responsible Party's Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country
Responsible Party's SSN *
Responsible Party's Email *
Responsible Party's Phone *
Responsible Party's Driver's License *
Owner 1 Full Name / Entity Name *
Owner 1 percent of ownership *
Owner 2 Full Name / Entity Name
Owner 2 percent of ownership
Owner 3 Full Name / Entity Name
Owner 3 percent of ownership
Owner 4 Full Name / Entity Name
Owner 4 percent of ownership
Owner Total Percentage Calculation
Other Owners' Drivers License(s) *

Manager of the LLC

All entities are required to have an individual designated to act as Manager of the LLC. This person handles the business of the company and is the “final word” in all company matters. There can be more than one Manager serving at the same time.

Will the Manager of the LLC be the same as the Responsible Party listed above? *
Yes
No
Manager's Name *
First
Last
LLC Manager's Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country
Would you like to list a Successor Manager? *
Yes
No
Successor Manager's Name *
First
Last
Successor Manager's Address *
Street Address
Address Line 2
City
State / Province
ZIP / Postal Code
Country
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