Jarrett | Hoyt
1795 Williston Road, Suite 125
South Burlington, VT 05403
(802) 864-5951
ESTATE PLANNING INFORMATION
Hello & Thank You for your interest in Jarrett & Hoyt. Please complete the Estate Planning Form below. If you have any questions, please contact our law office at
802.864.5951
. We look forward to working with you!
Jarrett & Hoyt are located at
1795 Williston Rd in South Burlington, Vt
in South Burlington, Vermont in the KeyBank Building near Burlington International Airport.
You will receive a TXT Message Reminder approximately 24 hours prior to your Appointment.
Please DO NOT USE EMAIL to send Sensitive Information. We use Clio & Microsoft Online Services for Client Relationship Management & Document Storage. We only request basic information unless you hire the firm to represent you in your legal matter.
We do not require your Social Security number unless it is for a specific reason -- such as where it is required for certain legal services such as for recording deeds, long term care applications, and probate, guardianship and trust administration matters. If we need this information, we will ask you to call our office and provide the number to us.
If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!
PERSONAL INFORMATION
Contact information
Prefix
First name
*
Middle name
Last name
*
Date of birth
Company
Emails
Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
Add email
Addresses
Street address
Country
Australia
Canada
United Kingdom
United States
---------------
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
City
State/Region
Alaska
Alabama
Arkansas
American Samoa
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Virginia
Virgin Islands, U.S.
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Province/Region
Zip/Postal code
Address type
Work
Billing
Home
Other
Primary
Default address false
Add address
Phone numbers
Phone number
Type
Work
Home
Mobile
Fax
Pager
Skype
Other
Primary
Add phone number
Date of Birth:
Marital Status:
Date of Marriage:
US Citizen:
Yes
No
Veteran:
Yes
No
First Marriage:
Yes
No
Occupation:
Spouse’s Name:
Date of Birth:
Marital Status:
Date of Marriage:
Home Phone:
Cell Phone:
US Citizen:
Yes
No
Veteran:
Yes
No
First Marriage:
Yes
No
Occupation:
Other Phone:
Email:
Mailing Address (if different):
Preferred Method of Communication?
How did you hear about Jarrett|Hoyt?
FAMILY INFORMATION:
List all children (biological, adopted, or step); if no children then list parents and/or siblings use the legal names of all relations
Family Member 1:
Yes
Legal Name:
Relationship to you:
Spouse:
Address:
Cell Phone:
Date of Birth:
Names & Ages of Children:
US Citizen:
First Marriage:
Home Phone:
Email:
Date of Death:
Is this person named as fiduciary on current estate planning documents?
No
Family Member 2:
Yes
Legal Name:
Relationship to you:
Spouse:
Address:
Cell Phone:
Date of Birth:
Names & Ages of Children:
US Citizen:
First Marriage:
Home Phone:
Email:
Date of Death:
Is this person named as fiduciary on current estate planning documents?
No
Family Member 3:
Yes
Legal Name:
Relationship to you:
Spouse:
Address:
Cell Phone:
Date of Birth:
Names & Ages of Children:
US Citizen:
First Marriage:
Home Phone:
Email:
Date of Death:
Is this person named as fiduciary on current estate planning documents?
No
Family Member 4:
Yes
Legal Name:
Relationship to you:
Spouse:
Address:
Cell Phone:
Date of Birth:
Names & Ages of Children:
US Citizen:
First Marriage:
Home Phone:
Email:
Date of Death:
Is this person named as fiduciary on current estate planning documents?
No
ASSET INFORMATION:
Please list each asset you own whether individually, jointly with another or held in trust or otherwise
REAL ESTATE:
Real Estate 1:
Yes
Property Address:
Owners:
How Titled:
Purchase Price:
Year Purchased:
Since Purchase have you subdivided, added parcels or adjusted boundaries?
Please provide all recorded documents relating to such alternations
Add attachment
Add attachment
Choose file
This file could not be attached because it exceeds the 50MB limit.
Please choose a file.
Cancel
Upload
Do you rent the property:
Current Value:
Mortgage Balance:
Explain:
No
Real Estate 2:
Yes
Property Address:
Owners:
How Titled:
Purchase Price:
Year Purchased:
Since Purchase have you subdivided, added parcels or adjusted boundaries?
Please provide all recorded documents relating to such alternations
Add attachment
Add attachment
Choose file
This file could not be attached because it exceeds the 50MB limit.
Please choose a file.
Cancel
Upload
Do you rent the property:
Current Value:
Mortgage Balance:
Explain:
No
Real Estate 3:
Yes
Property Address:
Owners:
How Titled:
Purchase Price:
Year Purchased:
Since Purchase have you subdivided, added parcels or adjusted boundaries?
Please provide all recorded documents relating to such alternations
Add attachment
Add attachment
Choose file
This file could not be attached because it exceeds the 50MB limit.
Please choose a file.
Cancel
Upload
Do you rent the property:
Current Value:
Mortgage Balance:
Explain:
No
Bank Accounts
Account 1:
Yes
Name of Bank
Owner of Acct
Type of Acct
Balance
Beneficiary?
No
Account 2:
Yes
Name of Bank
Owner of Acct
Type of Acct
Balance
Beneficiary?
No
Account 3:
Yes
Name of Bank
Owner of Acct
Type of Acct
Balance
Beneficiary?
No
Account 4:
Yes
Name of Bank
Owner of Acct
Type of Acct
Balance
Beneficiary?
No
Account 5:
Yes
Name of Bank
Owner of Acct
Type of Acct
Balance
Beneficiary?
No
Retirement Accounts (IRA, 401k, 403(b), SEP - do not include pension income)
Account 1:
Yes
Name of Financial Institution
Owner of Acct
Type of Acct
Current Value
Primary /Secondary Beneficiary
No
Account 2:
Yes
Name of Financial Institution
Owner of Acct
Type of Acct
Current Value
Primary /Secondary Beneficiary
No
Account 3:
Yes
Name of Financial Institution
Owner of Acct
Type of Acct
Current Value
Primary /Secondary Beneficiary
No
Account 4:
Yes
Name of Financial Institution
Owner of Acct
Type of Acct
Current Value
Primary /Secondary Beneficiary
No
Account 5:
Yes
Name of Financial Institution
Owner of Acct
Type of Acct
Current Value
Primary /Secondary Beneficiary
No
Brokerage Accounts (Stocks, bonds, and other non-qualified investments)
Account 1:
Yes
Financial Inst.
Owner of Acct
Type of Investment
Current Value
Beneficiary?
No
Account 2:
Yes
Financial Inst.
Owner of Acct
Type of Investment
Current Value
Beneficiary?
No
Account 3:
Yes
Financial Inst.
Owner of Acct
Type of Investment
Current Value
Beneficiary?
No
Account 4:
Yes
Financial Inst.
Owner of Acct
Type of Investment
Current Value
Beneficiary?
No
Account 5:
Yes
Financial Inst.
Owner of Acct
Type of Investment
Current Value
Beneficiary?
No
Life Insurance/Deferred Annuities
Policy 1:
Yes
Financial Inst.
Insured/Annuitant
Beneficiaries (primary/contingent)
Face/Cash Value
Death Benefit
No
Policy 2:
Yes
Financial Inst.
Insured/Annuitant
Beneficiaries (primary/contingent)
Face/Cash Value
Death Benefit
No
Policy 3:
Yes
Financial Inst.
Insured/Annuitant
Beneficiaries (primary/contingent)
Face/Cash Value
Death Benefit
No
Vehicles (cars, motor homes, boats, etc.)
Vehicle 1:
Yes
Owner
Make/model/Year
Loan Balance
Current Value
No
Vehicle 2:
Yes
Owner
Make/model/Year
Loan Balance
Current Value
No
Vehicle 3:
Yes
Owner
Make/model/Year
Loan Balance
Current Value
No
Vehicle 4:
Yes
Owner
Make/model/Year
Loan Balance
Current Value
No
Other Assets
(businesses -LLCs or partnerships, promissory notes, collections/ antiques/art, crypto-currency, NFTs, etc.)
Asset 1:
Yes
Owner
Description
Current Value
No
Asset 2:
Yes
Owner
Description
Current Value
No
Asset 3:
Yes
Owner
Description
Current Value
No
Asset 4:
Yes
Owner
Description
Current Value
No
Safe Deposit Box
Name of Owners/Leaseholders:
Box #:
Bank/Location:
Special Circumstances:
Family Members with Disabilities Pending Divorce Child Support or spousal obligations
Information Regarding Expected Inheritances
Other issues of concern
List of Advisors
CPA/Accountant:
Yes
Name
Contact
No
Financial Advisor:
No
Yes
Name
Contact
Other:
Yes
Name
Contact
No
May we contact your advisors to discuss your estate plan?
Yes
No
If a person you intend to nominate as a primary/successor agent, executor, trustee contacts our office, may we discuss your estate plan with them:
Yes
No
*Authorization to speak will continue unless you notify us in writing that we no longer have permission to discuss matters with your agent.
I/We acknowledge that the information provided by in this document will form the basis for the estate planning recommendations made by Jarrett|Hoyt and that the information contained herein is complete and accurate to the best of my/our knowledge.
Yes
ADDITIONAL INFORMATION FOR LONG TERM CARE CONSULTATIONS ONLY
Nursing or Residential Care Facility:
Daily/Monthly Costs of Care:
Long Term Care Insurance Benefit:
Housing Expenses
Rent/Mortgage (monthly):
Real Estate Taxes (annual):
Homeowner’s Ins. (annual):
Condo/HOA fees:
Health Insurance
Primary
Yes
Name of Provider
Premium/Month
No
Supplemental
Yes
Name of Provider
Premium/Month
No
Prescription
Yes
Name of Provider
Premium/Month
No
Other
Yes
Name of Provider
Premium/Month
No
Income Information- Monthly
Wages (gross)
Yes
Client
Spouse/Partner
No
Social Security (gross before Medicare)
Yes
Client
Spouse/Partner
No
Pension (gross)
Yes
Client
Spouse/Partner
No
Other:
Yes
Client
Spouse/Partner
No
Other:
Yes
Client
Spouse/Partner
No
List Any Significant Gifts or Reduced Value Sales of Assets Made Within Last 5 Years:
THANK YOU
When you are finished, please click the "
Submit
" button.