Kevin C. Martin Attorney at Law, PLLC

Welcome to Kevin C. Martin, Attorney at Law, PLLC
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.

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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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? *

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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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Are you/the applicant currently in a rehab, hospital or nursing home? *

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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
Please answer yes or no to the questions on this page.

Are you/the applicant a veteran? *

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Do you/the applicant have any estate planning documents (Will, POAs, Trusts)?

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Do you/the applicant have any children? *

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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

First Name *

Middle Name

Last Name *

Email *

Phone Number *

Date Of Birth *

Also known as(optional)

Is the applicant married? *

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Jr

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Sr

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Other

Gender

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Male

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Female

Your Address

Full Address: *

Address Line 1 *

Address Line 2

City *

State *

County *

Zip Code *

Is Your mailing address the same as your home address? *

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Applicant Spouse Information
Please use your legal name as it appears on your license or government-issue ID

Your spouse's Details

First Name: *

Middle Name

Last Name: *

Email *

Date Of Birth *

Cell *

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Other

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Gender

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Male

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Female

Is Your spouse's address different than you? *

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State: *

Children Information
Name your children and/or step children. Determine how to distribution your estate and when you would distributed.

How many children do you and/or your spouse/partner have?

Child’s Name *

Date Of Birth *

Parents of Child *

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(%)

Children

Do any of your children have a special need or disability? *

Yes No

Do you have any grandchildren? *

Yes No

Total Estate Size
When determining your total estate size, please include the approximate value of any real estate, bank accounts, investment accounts, retirement accounts, businesses, and other assets. Please do not include the death benefit of any life insurance. If you do not know this information, please select your best estimate. This information is only used to match you with the best team for your estate planning. We do request more specific asset information on the following pages. It is recommended that you add this additional asset information, but it is not required. By providing this additional information now, we can ensure your time spent speaking with our office during your appointment is as productive as possible.

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. *

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

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.

Applicant’s Income from Social Security

Applicant’s Pension Income

Applicant’s Other Income

Currently Employed?

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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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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
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 Beacon Legacy Group?

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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.

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