Intake form

Client/Grantor's Name (or names if more than one grantor)

Client/Grantor's Address

Client/Grantor's Telephone #:

Client/Grantor's Email:

Trustee's Name (or names if more than one trustee):

Trustee's Address (if different):

Trustee's Telephone # (if different):

Trustee's Email (if different):

Name of Successor Trustee (or names if more than one):

Address of Successor Trustee:

Your Estimated Adjusted Gross Income (AGI) for Current Year:

Desired Assets to Initially Fund iCLAT (cash, marketable securities, real property, closely-held entity LLC, LP interest, S corp. stock, etc):

Estimated Value of Total Assets to Initially Fund iCLAT:

Term of iCLAT (Years):

Amount of iCLAT's Annual Payment to Charity(ies):

If applicable, list your preferred charity(ies) and/or donor advised fund to be the recipient(s) of the annual charitable distributions from the iCLAT (provide name, IRS EIN/Tax Id# of any preferred charity(ies):

In the unlikely event that you fail to survive the term of the iCLAT, indicate how the iCLAT Assets are to be distributed at the end of term of the iCLAT:

Revocable Living Trust (If selected, provide name of trust below where indicated.)

Specific Family Member(s) or Other Person(s) - (If selected, provide names below where indicated.)

Otherwise (specify below where indicated)

My Estate (i.e. Pursuant to my Last Will & Testament, if any, otherwise by State's intestacy laws)

(Note: If none, then the iCLAT's name will be "[client's last name] Charitable Lead Annuity Trust Dated _________")

Preferred Name of iCLAT:

Name & Contact Information for Estate Planning Attorney (if any)

Name & Contact Info for Accountant/Enrolled Agent (if any):

Name & Contact Info for Financial Advisor (if any):

Upload Additional Documents (if any)