Estate Planning Intake Questionnaire

1 Your Information

Please provide your contact and identifying information.

Full Legal Name (required)

Former Names or Aliases

Date of Birth

Driver's License State

Social Security number and driver's license number will be collected securely at your consultation — not on this form.

Street Address

City

Parish

State

ZIP Code

Cell Phone

Email Address (required)

Preferred Contact Method

Contact Restrictions or Special Instructions

Citizenship Status

Current Employer

Occupation

Approximate Annual Gross Income

2 Marital & Family Status

Louisiana is a community property state. Your marital history directly affects how assets are classified and how your estate plan is structured.

Current Marital Status

Spouse Information

Spouse Full Legal Name

Spouse Date of Birth

Spouse Phone

Spouse Email

Spouse Employer

Spouse Occupation

Date of Marriage

Parish of Marriage

Prenuptial or Postnuptial Agreement?

Yes No Unsure

Deceased Spouse Information

Deceased Spouse's Name

Date of Marriage

Date of Spouse's Death

Was the Spouse's Succession Completed?

Yes No Unsure

Was There a Matrimonial Agreement (Prenuptial/Postnuptial)?

Yes No Unsure

Former Spouse Information

Former Spouse's Name

Date of Divorce

Was the Community Property Fully Partitioned?

Yes No Unsure

Any Prior Marriages?

Yes No

Prior Marriage Details

3 Children & Dependents

In Louisiana, children who are 23 or younger at your death (or children of any age with permanent mental or physical incapacity) may be "forced heirs" — meaning they have a guaranteed share of your estate that cannot be overridden by a will. Please provide accurate dates of birth.

Do You Have Children?

Yes No

Do You Have Grandchildren You Wish to Include in Your Plan?

Yes No

Grandchildren Names and Parents

Other Dependents (aging parents, disabled family members)?

4 Documents Requested

We recommend a comprehensive estate plan that includes all of the below documents. Each serves a distinct and important purpose.

Which Documents Do You Need? (check all that apply)

Last Will & Testament Revocable Living Trust General Power of Attorney Healthcare Power of Attorney / Medical POA Living Will / Advance Directive Tutorship Designation (for minor children) All of the above

Do You Have Existing Estate Planning Documents?

Yes No

What Documents and When Were They Executed?

Have You Been Told Your Existing Documents Need Updating?

Yes No

5 Last Will & Testament

Who Should Receive Your Estate? (names, relationships, what each receives)

Alternate Beneficiaries (if primary predeceases you)?

Anyone You Wish to Specifically Exclude?

Who Should Serve as Executor?

Alternate Executor?

If Minor Children: Who Should Serve as Tutor (Guardian)?

Alternate Tutor?

Specific Bequests (jewelry, heirlooms, sentimental items)?

Charitable Gifts?

Yes No

Organization Name and Amount/Percentage

Do You Want to Grant Your Surviving Spouse a Usufruct (Right to Use) Over Your Estate?

Yes No Need explanation

In Louisiana, a "usufruct" allows your surviving spouse to use and enjoy your property during their lifetime, while your children hold "naked ownership." Two kinds matter here: by law your spouse already receives an automatic legal usufruct over your share of community property (La. C.C. art. 890), which you cannot take away but which ends at the spouse's death or remarriage. Your will may grant a broader testamentary usufruct — for example, extending it over your separate property too, or making it last for life even if the spouse remarries. The choices below describe how far you want the usufruct to reach beyond the automatic legal one.

What Property Should the Usufruct Cover?

Community property only (legal default) All property (community and separate) Unsure — discuss with attorney

When Should the Usufruct Terminate?

At spouse's death only At spouse's death or remarriage (whichever first) Unsure — discuss with attorney

Should Your Spouse Have the Power to Consume (Use Up) Consumable Property?

Yes — full power over consumables No — non-consumable usufruct only Unsure — discuss with attorney

Do You Want Your Will to Authorize Independent Administration? (allows executor to handle estate matters without court supervision)

Yes (recommended) No Unsure — discuss with attorney

6 Revocable Living Trust

Louisiana recognizes the trust under La. R.S. 9:1721 et seq. (Louisiana Trust Code). A revocable living trust can help your family avoid the succession (probate) process.

Purpose of Trust (select primary reason)

Who Should Serve as Trustee?

Successor Trustee?

Trust Beneficiaries

Assets to Transfer into Trust

Distribution Instructions (select how assets should be distributed)

Special Needs Trust Provisions Needed?

Yes No

For Whom?

7 Power of Attorney

In Louisiana, a power of attorney must be in authentic (notarial) form to convey immovable property — La. Civ. Code art. 2993. We draft all POAs in notarial form to ensure maximum effectiveness.

General Power of Attorney

Who Should Serve as Your Agent?

Alternate Agent?

Specific Powers to Include or Exclude?

When Should the POA Be Effective?

Immediate (agent can act now) Springing (only upon my incapacity)

Healthcare / Medical Power of Attorney

Who Should Make Medical Decisions for You If You Cannot?

Alternate Healthcare Agent?

Any Specific Medical Treatment Preferences or Restrictions?

HIPAA Authorization

Do You Want a HIPAA Authorization Included? (allows your healthcare agent to access your medical records)

Yes (recommended) No

Additional HIPAA Recipients (anyone else who should have access to your medical records)?

8 Living Will / Advance Directive

Louisiana's Natural Death Act (La. R.S. 40:1151.1 et seq.) governs living wills. This document ensures your end-of-life wishes are respected.

Do You Want Life-Sustaining Treatment Withheld or Withdrawn If You Are in a Terminal and Irreversible Condition?

Yes No Unsure

Do You Want Life-Sustaining Treatment Withheld If You Are in a Persistent Vegetative State?

Yes No Unsure

Preferences on Artificial Nutrition and Hydration?

Continue Withdraw Let agent decide

Preferences on Mechanical Ventilation?

Continue Withdraw Let agent decide

Organ Donation Wishes?

Yes, all organs Yes, specific organs No Already registered

Any Specific Religious or Personal Beliefs That Should Guide End-of-Life Care?

9 Tutorship Designation

In Louisiana, a "tutor" is the legal guardian of a minor child. The tutorship designation in your will ensures your wishes are known if both parents pass away. La. Civ. Code art. 257.

Minor Children (auto-populated from Section 3, or list here)

Preferred Tutor (Guardian) — Name and Relationship

Alternate Tutor

Should the Tutor Also Manage the Children's Finances?

Same person (tutor handles both guardian and financial duties) Different person (separate undertutor for finances)

Undertutor Name (to manage finances)

Any Persons You Specifically Do NOT Want as Tutor?

Special Instructions for Children's Upbringing (education, religion, activities)?

S Spouse's Estate Plan Preferences

Since you and your spouse are both creating estate plans, please indicate your spouse's preferences where they differ from yours. For "mirror will" arrangements (most common), your spouse's plan will be the reverse of yours.

Is This a Mirror Will Arrangement?

Yes — mirror arrangement (each spouse leaves everything to the other, then to children) No — spouse has different preferences

Spouse's Executor Choice

Spouse's Alternate Executor

Spouse's General POA Agent

Spouse's Healthcare POA Agent

Spouse's Specific Bequests (if different from yours)

Any Other Differences from Your Plan?

10 Assets Overview

A complete picture of your assets allows us to design the most effective estate plan and identify potential tax or titling issues.

Real Property

Real Property (address, parish, approximate value, community/separate status, mortgages)

Do You Own Real Property Outside Louisiana?

Yes No

Out-of-State Property Details (state, address, approximate value)

Bank & Liquid Accounts

Bank Accounts (institution, approximate balance, joint/individual)

Investments & Retirement

Investment/Brokerage Accounts (type, institution, approximate value)

Retirement Accounts (IRA, 401k, pension) — Note: These typically pass by beneficiary designation, not through your will

Life Insurance & Business

Life Insurance (policy number, face value, type, who is insured)

Business Interests (entity name, ownership %, type of entity)

Personal Property

Vehicles (year, make, model, approximate value)

Valuable Personal Property (jewelry, art, collections, firearms)

Mineral Interests

Do You Own Any Mineral Rights, Royalty Interests, or Working Interests?

Yes No Unsure

Describe Your Mineral Interests (parish/county, type, producing or non-producing, approximate value)

Lifetime Gifts (Donations Inter Vivos)

Have You Made Any Significant Lifetime Gifts (donations of property, cash, or assets to children or others)?

Yes No

Describe the Gifts (to whom, what, approximate value, when)

Digital & Other Assets

Digital Assets (online accounts, cryptocurrency, digital media, important files)

Other Significant Assets

Approximate Total Estate Value

11 Liabilities

Mortgages (property, lender, approximate balance, interest rate)

Credit Card Debt (issuers, approximate total balance)

Personal/Student Loans (lender, balance, purpose)

Business Debts (if applicable)

Tax Obligations (income tax, property tax, other)

Any Pending or Anticipated Litigation?

Yes No

Describe the Litigation

Approximate Total Liabilities

12 Beneficiary Designations & Existing Planning

We will need to review all existing documents to ensure your new estate plan is consistent and complete.

Do You Have Beneficiary Designations on Retirement Accounts?

Yes No Unsure

Do You Have Beneficiary Designations on Life Insurance?

Yes No Unsure

Do You Have Payable-on-Death (POD) or Transfer-on-Death (TOD) Designations on Bank/Brokerage Accounts?

Yes No Unsure

Are Any Assets Already Held in a Trust?

Yes No

Do You Have an Existing Will?

Yes No

Date of Existing Will

Do You Have an Existing Power of Attorney?

Yes No

Do You Have a Living Will?

Yes No

13 Conflicts Check

Please list all persons and entities who may have an interest in your estate plan.

List All Parties Involved (including yourself, spouse, children, proposed executors, trustees, agents, tutors, and anyone else with an interest)

Have You Previously Been a Client of Aertker Legal?

Yes No

Are You Aware of Any Known Connections Between Any of the Parties Listed Above?

14 Your Goals & Additional Information

What Is Your Primary Goal for This Estate Plan?

Any Specific Concerns? (blended family, special needs child, Medicaid planning, business succession, etc.)

Is There Any Urgency?

Yes No

Describe the Urgency

Additional Information (anything else you'd like us to know)

How Did You Hear About Us?

Referred By (if applicable)

15 Acknowledgment & Signature

I certify that the information I have provided in this questionnaire is accurate and complete to the best of my knowledge. I understand that this questionnaire does not create an attorney-client relationship and that no attorney-client privilege attaches to this information until a written engagement agreement is executed. I authorize Aertker Legal, LLC to use this information in providing legal services to me.

Printed Name

Electronic Signature (type your full name)

Date

Estate Planning Intake Questionnaire

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