Welcome to our Digital Intake
Thank you for using our Digital Intake Form. Our firm collects this information to ensure you are meeting with the right team and gives us a head start on understanding your unique situation. By providing as much information as possible prior to your appointment, it allows us to make the best use of our time together during your first appointment. All information asked is optional and you only need to share information you are comfortable with disclosing. Additional details can be discussed during your appointment. Please select the reason for meeting with our office. If you are not sure, please select Other and add a brief note about why you contacted our office. By knowing what is most important to you, it helps our firm better prepare to answer your questions.
Thank you for visiting our Digital Intake.

Have you met with our office before? *
Yes
No

Applicant Information
Please let our office know if you are completing this intake for yourself or a loved one. If for a loved one, please indicate your relationship to the applicant. By providing our office with information regarding any health issues, it helps us to get an understanding of what care may be needed in the future or possible benefits you may be eligible to receive. If you are interested in special needs planning, please do not complete this intake with information for the child or beneficiary with a special need. The person that would like to set up planning for the person with a special need should complete this section. There will be a section to add information on the person with a special needs later in this intake.
Are you filling this out for yourself or for your loved one? *
For a Loved One
For Myself
Do you have any health issues? *
Yes
No
Are you/the applicant currently in a rehab, hospital or nursing home? *
Yes
No


General Information
Please answer yes or no to the questions on this page.
Are you/the applicant a veteran? *
Yes
No
Do you/the applicant have any estate planning documents (Will, POAs, Trusts)?
Yes
No

Personal and Family Information
If you are completing this form for yourself, please enter your information and, if applicable, your spouse’s information. If you are completing this form for a loved one, please enter their information and spouse’s, if applicable, and your information.
Applicant Information
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Is the applicant married? *
Yes
No
Are you US citizens? *
Yes
No
Suffix (optional)
Jr
Sr
II
III
Other
Gender
Male
Female
Have you been married previously?
Yes
No
Have you entered into a pre-marital or post-marital agreement?
Yes
No
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Children and Beneficiaries
If you have minor children, you will be provided with the option to establish a trust for their benefit. A children's trust is a trust funded after your passing. The trust is held for the benefit of your children until they reach a certain age. This allows for a trustee to manage a child’s inheritance until they reach a mature age.
Do you have any children or are you the legal guardian of any children? *
Yes
No

Total Estate Value
The value of your total estate includes all assets held in your individual name, jointly, or that you control. Assets can include, but are not limited to, real estate, your retirement accounts, bank accounts, brokerage/stock accounts, business interests, and valuable jewelry and collectibles. The value of the assets goes by either the amount of money held in the account or the fair market value of any real estate, tangible property, or intangible asset (e.g. business interest).
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Do you own real estate outside of the Commonwealth of Pennsylvania? *
Yes
No

Real Estate
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own a home?
Yes
No

Estate Planning Objectives

If your spouse survives you, do you want to leave the assets to your spouse outright and trust that they will leave them to your children?
Yes
No

Do you want to make any charitable gifts at your death?
Yes
No


Assets Information
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own any checking or savings accounts? *
Yes
No
Do you/the applicant own any retirement accounts? *
Yes
No
Do you/the applicant have any outstanding debt besides a mortgage? *
Yes
No

Assets Information Continued
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own any investment or non-retirement accounts? *
Yes
No
Do you/the applicant own a business? *
Yes
No
Do you/the applicant own any life insurance policies? *
Yes
No
Do you work with a financial advisor? *
Yes
No
Do you have any additional information to share or comments that would be helpful to know about your assets? *
Yes
No

Monthly Income
Please provide your monthly income information on this page. By knowing your monthly income, it helps our firm know what types of benefits you may be eligible for.
Please add your/the applicant’s income information for any applicable sources.

Currently Employed?
Yes
No

Is your spouse currently Employed?
Yes
No

Executor
The Executor (also known as a Personal Representative) is the person appointed by a probate court to settle your estate. The Executor’s job is to identify and obtain access to your assets, make sure that your expenses and taxes are paid and distribute assets to your beneficiaries. The Executor’s role is both financial and managerial. Therefore, consider naming someone who you believe is good with finances or who would be willing to get professional help to guide them so that they can make prudent and reasonable decisions. We recommend not choosing to have Executors serve jointly as this can unnecessarily complicate the administration of your estate since the co-Executors will have to make decisions jointly and both may be required to sign court filings, contracts, checks, and other documents. If you decide that you would like your agents to serve jointly, please consider selecting individuals who get along. Previous
Who do you wish to handle your final affairs (e.g., Executor or Successor Trustee) such as paying any debts and expenses, filing any taxes that may be due, and managing and distributing your assets according to the terms of your estate plan?
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Additional Information


Referral Information
We are so happy you found us, and we would like to know where you learned about our firm. This information helps us to ensure we are marketing in the correct areas and thanking our referrals. All client information is kept confidential when sending thank you notes.
How did you learn about Florio Perrucci Group?
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Attorney-in-fact
Your attorney-in-fact will manage your business and financial affairs during your lifetime (e.g. paying your bills, filing taxes, making investments). The attorney-in-fact operates under a “Durable Power of Attorney” that takes effect immediately. When choosing an attorney-in-fact you should consider someone with knowledge of your finances and their ability to manage such. You should name an alternate in the event your first choice is unable to serve. Most clients appoint their spouse to serve as first choice. Please state your choices.
Do you wish to use same agents as your Executor? *
Yes
No
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Advance Medical Directive
Your agent will be responsible for personal and medical decisions for you if you are incapacitated and cannot do so yourself. You should consider alternates in case your first choice is unable to serve. Most clients appoint their spouse to serve as first choice. Please state your choices.
Do you wish to use same agents as your Financial Power of Attorney? *
Yes
No
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Assets
Briefly detail your assets so we can determine the best estate planning methods for you. Do not worry about being exact with the fair market value (approximations are acceptable).
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Do you have any investment or vacation properties?
Yes
No


Summary
Summary
Click the “Submit” button below to proceed and get your selected estate planning documents. Your information will be sent to our office, and you’ll be prompted to schedule a meeting with a legal professional to review your documents.