Southmselderlaw

Welcome to the Mayhone Elder Law Adult Incapacity Plan!

Before you begin, here are a few tips to guide you:

1. Answer thoughtfully, but do not overthink it. These questions are designed to help you consider important decisions. All responses will be reviewed by a qualified attorney and can be revised as needed.

2. The process is quick and easy, typically taking about 15–20 minutes to complete.

3. You can revisit the site at any time to make updates or changes using the username and password you created.

4. Once you are satisfied with your answers, click “Submit” to finalize them. You will then be directed to complete payment for your plan.

5. After submission and payment, a licensed attorney will review your responses and prepare the documents for signing.

If you run into any issues or problems, reach out to our team for assistance at (228) 215-1223

Registration Info
Please use your legal name as it appears on your license or government-issue ID

Provide your details below to get started on your Plan.

First Name *

Middle Name

Last Name *

Email *

Password *

Cell *

Your Contact Details
If you are married, your spouse will be defaulted as your primary agent throughout this interview. Please know that you are not required to have your spouse as your primary agent and you may choose to have another individual act as your primary helper.Please submit all answers with the proper capitalization. Your full legal name is required for your estate planning documents. This would be the name you are referred to on your driver’s license, social security card, passport or other federal government ID. Do not forget to add your middle name or initial if you have one. If your driver’s license, social security card, passport, or other forms of identification do not match, use the full name indicated on your driver’s license and list the other name in the “also known as” field. Also known as names are names that you may regularly use for financial documents, health care policies, or just more commonly known as.

Name:

Date Of Birth *

Also known as(optional)

Are you married? *

✓

Yes

✓

No

Suffix(optional)

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

What are your personal pronouns?

✓

he/him

✓

she/her

✓

they/them

Your Address

Full Address: *

State

County *

Next, we’ll ask you a few questions to help design your plan. Let’s get started!

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

Your spouse's Details

Spouse Legal First Name *

Spouse Legal Middle Name

Spouse Legal Last Name *

Email *

Date Of Birth *

Cell *

Suffix(optional)

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

Also known as(optional)

Gender

✓

Male

✓

Female

Is Your spouse's address different than you? *

✓

Yes

✓

No

Power of Attorney
The Power of Attorney allows the person you name as your agent to make legal and financial related decisions for you while you are alive. The power will become effective at the time you sign the Power of Attorney and will continue in the event of your incapacity. The Power of Attorney powers stop upon your death. It is recommended that you name one primary (typically spouse/partner if married) and at least one alternate agent.

Provide the information of one or more individuals who will serve as your agent under the Durable Power of Attorney:

Primary Agent: *

Phone Number *

Full Address: *

Alternative Agent: * Click the "+" button to add another alternative agent

Phone Number: *

Full Address: *

Power of Attorney-Spouse/Partner
The Power of Attorney allows the person you name as your agent to make legal and financial related decisions for you while you are alive. The power will become effective at the time you sign the Power of Attorney and will continue in the event of your incapacity. The Power of Attorney powers stop upon your death. It is recommended that you name one primary (typically spouse/partner if married) and at least one alternate agent.

Primary Agent: *

Phone Number *

Address *

Alternative Agent: * Click the "+" button to add more agents.

Phone Number *

Address *

Health Care Power of Attorney
The Healthcare Power of Attorney allows the person you name as your agent to make medically related decisions for you while you are alive. These powers become effective in the event of your incapacity. It is recommended that you name one primary and at least one alternate agent.

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? *

✓

Yes

✓

No

Primary Agent: *

Alternative Agent: * Click the "+" button to add more agents.

Would you like to be an organ donor?

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Yes﹐for transplantation purposes only

✓

Yes﹐for transplantation﹐education and/or research

✓

No

Health Care Power of Attorney Spouse/Partner
The Healthcare Power of Attorney allows the person you name as your agent to make medically related decisions for you while you are alive. These powers become effective in the event of your incapacity. It is recommended that you name one primary and at least one alternate agent.

Provide health care agent to make medical conditions on your behalf

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? *

✓

Yes

✓

No

Primary Agent: *

Alternative Agent: * Click the "+" button to add more agents.

Would you like to be an organ donor?

✓

Yes﹐for transplantation purposes only

✓

Yes﹐for transplantation﹐education and/or research

✓

No

Congratulations! You have completed your online estate plan interview!

Please review your responses carefully. Once you’re satisfied, click ‘Submit’to send your interview to us. This is an important step toward completing your estate plan.

After submitting:

1. You will be directed to a webpage to pay for your plan.

2. Once payment is received, our office will reach out to schedule your plan review and signing session.

3. During this session, our team will walk you through your plan, answer any questions, and ensure everything reflects your wishes.

4. After the review, we’ll guide you through the proper signing and execution process so you leave with a fully active and effective plan.

Important: Your estate plan is not complete until it is properly signed and executed. We are not engaged to provide assistance until payment has been received.

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