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919-663-2471
Email
fadelylaw@me.com
Welcome to Fadelylaw
Thank you for visiting our Digital Intake.
Please let us know what you are here for and select all that apply.
Estate Planning
Nursing Home Planning
Dementia Planning
Tax Protection Planning
Special Needs Planning
Other
Have you met with our office before?
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Yes
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No
Applicant Information
Are you filling this out for yourself or for your loved one?
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For a Loved One
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For Myself
What is your relationship to the applicant?
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Parent
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Sibling
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Family Member
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Friend
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Child
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Other
Do you have any health issues?
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Yes
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No
Please describe below. If married, please indicate the spouse’s name for the health issues.
Are you/the applicant currently in a rehab, hospital or nursing home?
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Yes
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No
Please enter the name of the facility and date of admission. If married, please indicate which spouse is in a facility.
If you are considering moving into a facility, please list what facilities you are considering or looking into. If you are currently on a waitlist, please list the name of the facility. If you need assistance selecting a facility, please note below.
Please list the name of the facility
General Information
Are you/the applicant a veteran?
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Yes
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No
Please provide dates of service and any service-related disability.
Do you/the applicant have any estate planning documents (Will, POAs, Trusts)?
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Yes
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No
Please list the estate planning documents you have and if they are in your possession or held with another law firm.
Do you/the applicant have any children?
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Yes
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No
Information
Applicant Information
First Name
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Middle Name
Last Name
*
Email
*
Phone Number
*
Date Of Birth
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Also known as(optional)
Is the applicant married?
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Yes
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No
Are both you and your spouse US citizens?
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Yes
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No
Suffix(optional)
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Jr
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Sr
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II
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III
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Other
What are your personal pronouns?
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he/him
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she/her
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they/them
Your Address
Full Address:
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Address Line 1
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Address Line 2
City
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State
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Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County
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Zip Code
*
Is Your mailing address the same as your home address?
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Yes
✓
No
Applicant Spouse Information
Your spouse's Details
First Name:
*
Middle Name
Last Name:
*
Email
*
Date Of Birth
*
Cell
*
Suffix(optional)
✓
Jr
✓
Sr
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II
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III
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Other
Also known as(optional)
What are your spouse's pronouns?
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he/him
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she/her
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they/them
Is Your spouse's address different than you?
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Yes
✓
No
Full Address:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Contry:
*
Zip Code:
*
Is Your spouse's mailing address the same as her home address?
✓
Yes
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No
Children Information
How many children do you and/or your spouse/partner have?
Child’s Name
*
Date Of Birth
*
Parents of Child
*
You
Your Spouse
You and Your Spouse
Other
How do you wish to distribute your estate to your children?
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Split shares equally
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Split shares as Follows
Percentage(%)
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0
10
20
30
40
50
60
70
80
90
100
Children
*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Do any of your children have a special need or disability?
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Yes
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No
Please Provide additional information
Do you have any grandchildren?
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Yes
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No
Grandchild Name
*
Date of Birth
*
Parent Of Child
*
You
Your Spouse
You and Your Spouse
Other
Total Estate Size
In order to match you with the team that can best serve you, we need information about your total estate size. Please select the option below that best fits your total estate size.
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Less than $250000
$250000 - $500000
$500000 - $1.5 million
more than $1.5 million
Real Estate
Do you/the applicant own a home?
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Yes
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No
Real Estate Description
Real Estate Value
Do you/the applicant have a mortgage?
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Yes
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No
Mortgage Value
Assets Information
Do you/the applicant own any checking or savings accounts?
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Yes
✓
No
Add Cash/Saving Account
Value
Do you/the applicant own any retirement accounts?
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Yes
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No
Retirement Accounts
Value
Do you/the applicant have any outstanding debt besides a mortgage?
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Yes
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No
Add Debts
Value
Assets Information Continued
Do you/the applicant own any investment or non-retirement accounts?
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Yes
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No
Add Account
Value
Do you/the applicant own a business?
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Yes
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No
Business Interests Name
Value
Do you/the applicant own any life insurance policies?
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Yes
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No
Life Insurance Policies
Value
On Life of(check one)
Both
You
Spouse
Do you work with a financial advisor?
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Yes
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No
Add Name
Add Company
Do you have any additional information to share or comments that would be helpful to know about your assets?
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Yes
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No
Additional Comments
Monthly Income
Please add your/the applicant’s income information for any applicable sources.
Applicant’s Income from Social Security
Applicant’s Pension Income
Applicant’s Other Income
Currently Employed?
✓
Yes
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No
Location
Applicant’s Salary
Applicant’s Spouse Income from Social Security
Applicant’s Spouse Pension Income
Applicant’s Spouse Other Income
Is your spouse currently Employed?
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Yes
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No
Location
Applicant’s spouse Salary
Additional Information
Please share your reason for meeting with our office and/or any relevant information that you would like our office to know prior to meeting you.
Referral Information
How did you learn about Beacon Legacy Group?
Please select one of the following
*
Friend - Relative - Colleague - Etc
Financial Advisor
Account
Newspaper
Facebook
Internet Search
Other
Person’s Name
Submission Screen
Click the “Submit” button below to complete your application. Once submitted, your information will be sent to our office. You will then be prompted to schedule a phone call or Zoom meeting to review your documents with a legal professional.
I intend to go through the POA and Young Adult Versions in the next 24 hours.
Submit
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Welcome to Fadelylaw
Applicant Information
General Information
Information
Applicant Spouse Information
Children Information
Total Estate Size
Real Estate
Assets Information
Assets Information Continued
Monthly Income
Additional Information
Referral Information
Submission Screen
