Simple Will Intake Form


In a Simple Will, except for specific bequests (see below), your entire estate will either go to your spouse, or to your children, if your spouse dies before you. If you are interested in this type of a Simple Will, then please complete this form and return it to SHAMY, EL FADEL & MAHONE.

You may fill out this Simple Will Intake Form and send your completed form to our firm by pressing the “Submit Form” link below. Otherwise, you can download a copy of this form, complete at your convenience, and submit the completed form to our firm either by facsimile to 561-750-5083, or by email to:

Upon submission of your completed form either by submission by selecting the “Submit Form” link below, or by facsimile or email as indicated above if downloaded, the Intake Form a staff member of our firm will contact you to schedule your free consultation to discuss our engagement for the preparation of your Last Will and Testament and any other ancillary estate planning instruments based upon your subjective requirements.


    1. Personal Information:

    Marital Status: MarriedSingle

    2. Spouse's Information:

    *** If you are not married, please list the names and address of the persons
    or charitable organizations that you want to receive your assets upon your death:

    3. Marital Information:

    Have you ever divorced? YesNo

    4. Your Dependents

    List your Children and Age:
    *** If your children are minors (under 18 years), then please state the name and
    address of the individual(s) you would like to recommend for guardianship [i.e.;
    to care for your children and their inheritance]:

    **** If one of your children is a minor when you die, do you want that child’s
    inheritance to go into a simple trust to prevent the minor child from spending the
    inheritance, until s/he is: 18 years21 years25 years

    *** If one of your children or beneficiary (ies) dies before you, do you want his or
    her share of your estate to go to your other living children? YesNo

    – or –

    Do you want your deceased child’s share of your estate to go to his or her issue
    (i.e.; children/grandchildren of that deceased child) YesNo

    5. Specific Bequests:

    Do you want to make any specific bequests? (For example: my wedding ring to
    daughter or my gold watch to my nephew)? If so, then state:

    6. Disinherit:

    Do you want to exclude any individuals from your will? YesNo

    If yes, then state Full Name of Each Person(s) to be disinherited:

    *** Do you want to disinherit an individual if he or she contests your Will? YesNo

    7. Executor

    Who do you want to be your Executor [the person that would administer your will?]
    In most cases, this will be your spouse. If Spouse check here Spouse

    If some other person(s), then state the full name and address of person:

    *** Please provide name and address of Alternate Executor to be appointed in case
    the person that you have named Executor is unable or unwilling to perform the duties:

    8. Burial Requests:

    Do you have any special requests for your funeral or burial? YesNo

    Specific Directions for Your Funeral:

    Cremation YesNo

    9. Living Will/Durable Healthcare Proxy and Power of Attorney:

    Are you interested in a Power of Attorney, Living Will [Do Not Resuscitate Order] or
    Durable Healthcare Proxy [allows a person to make decisions concerning your healthcare if you cannot]? YesNo

    **** If yes, then please state the name, address and telephone number of the person
    you would like to name as your Power of Attorney (person who will make health decision on your behalf):

    Please indicate name, address and telephone number of Alternate Person to Act:

    Once we receive your submitted form, our office will contact you to schedule a free consultation to discuss your estate planning needs and to formalize an engagement, at your option, to prepare your estate planning instruments.

    Please note that preparation of the Last Will and Testament requires an official engagement of our firm’s services. The submission of this form in itself does not constitute an engagement of legal services with our firm. Notwithstanding. the information provided on the form is however kept confidential and privileged whether or not you retain our firm for services.