Warren & Migliaccio

REGISTRATION PAGE FOR YOUR YOUNG ADULT

First Name *

Last Name *

Email *

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Instructions to start the Young Adult Incapacity Plan!

Here are a few tips before you begin:

1. This will be quick and easy! Your answers will be reviewed with a qualified attorney and can be changed.

2. This will take you less than 5 minutes to complete.

3. Your documents will be reviewed and then emailed to you and you can re-visit the site anytime to make changes.

4. At the end, you will be able to list any questions you have that the questionnaire didn’t address or to add any additional information you would like us to know.

NOTE: If you are completing this by phone, please turn your screen sideways.

Young Adult Info

Are you a parent filling this out for your college student? *

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Yes

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No

Please select "Are you a parent filling this out for your college student?".

Your Contact Details
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)

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: *

State

Financial Power of Attorney
You will need to name the person who can manage your money, bills, and accounts if you are unable to do so—this person is called your Financial Agent. You will first choose a Primary Agent and then name a Successor Agent as a backup in case your first choice cannot serve. This arrangement, known as a Power of Attorney (POA), gives your agent the authority to act under the powers you grant without having to go through the court process. If you decide to have agents serve jointly, they must make decisions together; if not, either agent may act independently. If you are unsure about the best option, your Miller Law Office attorney can assist you at 888-611-9511.

Decide who should handle money, bills, and accounts if the person this plan is for cannot—their trusted money helper, known as the Financial Agent. Begin by naming your first choice, then list a backup, called the Successor Agent.

Primary Agent: * Click "+" to add agent

Street Address: *

City: *

State: *

Zip: *

Phone Number: *

Medical Power of Attorney
Choose the person who can make medical decisions for you if you are unable to communicate or decide for yourself—this person is called your Medical Agent. A Medical Power of Attorney (Medical POA) only applies while you cannot make decisions on your own and ends once you are able to do so again. It is best to name one primary agent and at least one backup, who would serve in the order you list them. If you appoint two agents to serve together, or “joint,” they must agree on all decisions. If you have questions, your Miller Law Office attorney can guide you at 888-611-9511.

Pick who should make medical decisions if the person this plan covers is unable to do so. List your first choice, then add a backup.

Do you wish to use the same agents as your Financial Durable POA? *

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Yes

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No

Primary Agent: * Click "+" to add agent

Street Address: *

City: *

State: *

Zip: *

Phone Number: *

Submission Screen

You’re almost done. When you submit, our team will review your information, resolve any gaps, and prepare your documents. You’ll have a chance to ask questions and confirm details before anything is finalized.

If you would like to review your responses, you can select each screen and review your answer or select the preview button which will open a print screen page. Click the “Submit” button below to be directed to a page where you will be able to pay for your chosen plan. After payment is received, your information will be securely sent to our office for preparation of your documents.

Preview Answers

Your Progress