Fillable Printable Letter of Intent Sample Format
Fillable Printable Letter of Intent Sample Format
Letter of Intent Sample Format
LETTER OF INTENT
FOR
_______________________
TO WHOM IT MAY CONCERN:
This letter is being written in conjunction with my estate planning
and as a supplement to my trust and will. The thoughts expressed in
this letter should not be considered rigid or binding and they should
always be tempered by a careful consideration of the facts and
circumstances existing when a decision has to be made.
In any situation where the provisions of this letter may be deemed to
be inconsistent with, or contrary to the terms of my trust, will or other
formal estate planning instruments, it is my desire and intent that the
provisions of my trust, will and other formal estate planning
documents shall govern and be controlling.
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INSTRUCTIONS FOR LETTER OF INTENT
Please use this model Letter of Intent as a guide to writing your own Letter of Intent. When completed,
this letter shall inform your loved ones of the following:
Personal information about you and your family history
Location of important documentation
Individuals to contact whom are involved in your financial and legal affairs
Your financial desires and wishes in connection with the following:
Burial arrangements
End of life decisions
The distribution of certain personal properties
This is your last letter and words to your family and friends. You may revise it any time. It requires no
witnessing or notarization. Keep the original of the letter in your safe deposit box and a copy in an
accessible area where your family and/or loved ones can locate it when the need arises. Please keep your
address book current and in an easily accessible place so your family and/or loved ones are able to
ascertain accurate contact information.
Ideally, we advise that you make a file folder for each of the following items to help you stay organized:
Advance Health Care Directives
Attorney
Bank Accounts
Benefits
Birth Certificate(s)
Bonds/Securities
Brokerage Accounts
Burial Information
Certified Public Accountant
Caregivers
Cars/Vehicles
Cemetery Information
Cherished Possessions
Church Contacts
Comforting Acts
Contracts
Safe Deposit Box
Divorce Papers
Estate Planning Documents
Financial Statements
Funeral Home Information
Going-Away Party
Hospice
Instant Action Folder (immediate
information required at time of death)
Insurance
Inventory
Loans
Long-Term Care Information
Marriage License(s)
Memorial Service
Military Papers
Mortgage Papers
Obituary
People to Notify
Real Estate Titles
Social Security/Medicare Information
Stages of Grief
Stocks/Mutual Funds
Tax Returns
“Ten Best Things” List
“Things I Want To Do Before I Die”
What To Do When Death Occurs
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Health Information
Health Care Advisors
Primary Physician:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Alternate Physician:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Alternate Physician:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Dentist:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Eye Doctor:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Pharmacy:
_________________________________
Phone Number:
_________________________________
Address:
_________________________________
Prescriptions
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
Medication: ______________________
Physician: ______________________
Dosage: ______________________
Date prescribed: ___________________
Pharmacy: ______________________
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Over-the-Counter Medications
Medication: ____________________
Dosage: _______________________
Medication: ____________________
Dosage: _______________________
Medication: ____________________
Dosage: _______________________
Medication: ____________________
Dosage: _______________________
Medication: ____________________
Dosage: _______________________
Medication: ____________________
Dosage: _______________________
Personal History
Chronic/Ongoing Illness
______________________________
Date of Onset
______________________________
Treatment and Medication
______________________________
______________________________
Chronic/Ongoing Illness
______________________________
Date of Onset
______________________________
Treatment and Medication
______________________________
______________________________
Chronic/Ongoing Illness
______________________________
Date of Onset
______________________________
Treatment and Medication
______________________________
______________________________
Surgery/Date/Outcome
______________________________
______________________________
______________________________
Surgery/Date/Outcome
______________________________
______________________________
______________________________
Family History (attach additional page if necessary)
Name: __________________________
Relationship: _____________________
Illness or Condition:
________________________________
Age of Onset: _____________________
Age of Death: _____________________
Name: __________________________
Relationship: _____________________
Illness or Condition:
________________________________
Age of Onset: _____________________
Age of Death: _____________________
Name: __________________________
Relationship: _____________________
Illness or Condition:
________________________________
Age of Onset: _____________________
Age of Death: _____________________
Name: __________________________
Relationship: _____________________
Illness or Condition:
________________________________
Age of Onset: _____________________
Age of Death: _____________________
Name: __________________________
Relationship: _____________________
Illness or Condition:
________________________________
Age of Onset: _____________________
Age of Death: _____________________
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Insurance (see Exhibit A for additional Information)
Health Insurance Agent: ____________________
Phone Number: ________________
Address: ________________________________________________________________
Health Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Life Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Life Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Life Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Auto Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Auto Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Homeowners Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Umbrella Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Long Term Care Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Disability Insurance Agent: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
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Personal Profile
Social Security Number: _____________________
Address: _________________________________
_________________________________
Date of Birth: _________________________________
Place of Birth: _________________________________
Citizen of: _________________________________
Parents
Father’s Name: ___________________________
Stepfather’s Name: _____________________
Date of Birth: _________________________________
Mother’s Name: ___________________________
Stepmother’s Name: _____________________
Date of Birth: _________________________________
Marital Status
Married ______ Divorced ______
Widowed ______ Never Married ______
Spouse’s Name: ____________________________
Date of Marriage: ___________________________
Previous Spouse(s): (1) ______________________ (2) ________________________
Date of Marriage: (1) ______________________ (2) ________________________
Date of Divorce: (1) ______________________ (2) ________________________
Children (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
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Children cont. (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Grandchildren (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
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Grandchildren (cont.) (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ # of Children: ______________________
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10/19/2011
Great-Grandchildren (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Spouse: ______________________ # of Children: ______________________
Name: ______________________ DOB: ______________________
Social Security Number: ______________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Spouse: ______________________ # of Children: ______________________
Brothers and Sisters (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
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10/19/2011
Brothers and Sisters (cont.) (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
Other Next of Kin (attach additional page if necessary)
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
Name: ______________________ DOB: ______________________
Living or Deceased: ___________________ Social Security #: __________________
Address: ______________________________________________________________
Home Phone #: ______________________ Work Phone #: _____________________
Cell Phone #: ______________________ Email Address: ______________________
Spouse: ______________________ Living or Deceased: _________________
Children: ______________________________________________________________
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Friends and Neighbors
Friend: ______________________ Phone Number: ______________________
Email Address: ______________________
Friend: ______________________ Phone Number: ______________________
Email Address: ______________________
Friend: ______________________ Phone Number: ______________________
Email Address: ______________________
Friend: ______________________ Phone Number: ______________________
Email Address: ______________________
Neighbor: ______________________ Phone Number: ______________________
Email Address: ______________________
Neighbor: ______________________ Phone Number: ______________________
Email Address: ______________________
Guardian for your minor child(ren):
First Choice Guardian: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Email Address: ___________________________________________________________
Second Choice Guardian: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Email Address: ___________________________________________________________
Third Choice Guardian: ______________________
Phone Number: ______________________
Address: ________________________________________________________________
Email Address: ___________________________________________________________
If appropriate, please provide factors you considered for choosing the individuals designated in your
Nomination of Guardians. This is particularly helpful if you anticipate any other individuals questioning
or contesting the designated guardians.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
