Estate FB FK Law Firm

Welcome and Registration

To get started, please provide your information below. This information will be used to generate your Power of Attorney documents.

Your privacy and security are important to us. Please Note: This site is database-driven and utilizes a secure, encrypted MySQL database to protect all data and passwords. We understand that you are providing sensitive information, and this application has been developed to meet industry-standard security requirements, including those used for PCI-protected environments. If you prefer not to enter certain information online, you may leave those fields blank. Once you hit “Submit,” you will have the opportunity to edit and adjust the generated Word document before finalizing it.

First Name *

Middle Name

Last Name *

Email *

Password *

Phone Number *

Your Contact Details

Name:

Date Of Birth *

Are you married? *

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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

Gender?

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Male

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Female

Your Address

Full Address: *

Address Line 1 *

City *

State *

County *

Zip Code *

Is your mailing address the same as your home address?

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Yes

✓

No

Your Spouse Information

Your spouse's Details

First Name: *

Middle Name *

Last Name: *

Email *

Date Of Birth *

Cell *

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

Please select "Suffix(optional)".

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

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No

State: *

Executor

Please name 3 people who will serve as the Executor of your Last Will and Testament.

(Your Executor is responsible for carrying out your instructions and wishes as provided in your will. If you are married, your spouse will be named as Executor. Please list at least one other individual to be named as Alternate Executor.)

Executor Full Legal Name *

Alternate Executor Full Legal Name

Second Alternate Executor Full Legal Name

Executor - Spouse/Partner

Primary Executor *

Financial DPOA:

Name 3 people to serve as your agent under the Durable Power of Attorney.

(The DPOA allows the person you name as your agent to make financial and property related decisions for you. The power can become effective at the time you sign the DPOA or later only in the event of your incapacity. This choice will be made at the time you sign the document.)

Do you wish to use same agents as your Executor?

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Yes

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No

Primary Agent Full Legal Name *

Phone Number

Address (Please include City, State and Zip code)

Alternate Agent Full Legal Name

Phone Number

Address (Please include City, State and Zip code)

Second Alternate Agent Full Legal Name

Phone Number

Address (Please include City, State and Zip code)

Financial DPOA-Spouse/Partner

Primary Agent: *

Phone Number *

Address *

Health Care POA

Name 3 people to serve as your agent under your Medical Power of Attorney.

(A Medical Power of Attorney allows an Agent to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself. If you are married, your spouse will be named as your Agent. Please name at least one individual as an Alternate Agent.)

Do you wish to use same agents as your Power of Attorney? *

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Yes

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No

Primary Agent Full Legal Name *

Phone Number *

Address *

Alternate Agent Full Legal Name

Phone Number

Address

Second Alternate Agent Full Legal Name

Phone Number

Address

Health Care POA - Spouse/Partner

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Power of Attorney? *

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Yes

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No

Primary Agent: *

Phone Number *

Address *

HIPAA Agents

All of the persons named in your Durable Power of Attorney and Medical Power of Attorney will be listed in your HIPAA release.

Use the same agents from your Health Care Power of Attorney?

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Yes

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No

Agent Name

Agent Address

Agent Phone

Directive to Physician

Your plan will include a Directive to Physicians document also known as Living Will.

Signing Your Documents

Please contact us to schedule the signing, this will be at our office.

Summary

If you would like to review your responses, please review your responses on the right hand side on the specific screens. After you click submit, you will be finished and we will email your answer and the office will contact you with the next steps .

Your Progress