CCP Changes Request Form

Required questionnaire for any changes to your documents you would like.

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Your Name(Required)

First Last

Your Address

Add new or most recent addresses here for our records.

Street Address Address Line 2 City State ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Who do you nominate to act as your Supported Decision-Maker?

Please list below.

Do you have any further changes to your Estate Plan?

If no further changes to your Estate Plan, select no and proceed to the Submit button at the bottom of this form.

Yes, I'll describe below.

No further changes.

Distribution

Do you have changes to the distribution of your Estate upon your passing?

Personal Representatives

Would you like to change who you nominate to serve as your Personal Representative in your Last Will & Testament?

Power of Attorney

Would you like to change who you nominated to serve as your Durable Power of Attorney?

Living Will

Would you like to change who you have nominated as your Surrogate?

Health Care Surrogate

Would you like to change who you have nominated as your Heath Care Surrogate?

HIPAA Release

Would you like to change who you have nominated in your HIPAA Release?

Disposition of Bodily Remains & Funeral Preference

Would you like to change the Disposition of Bodily Remains & Funeral Preference?

Questions, comments, concerns or other life changes not mentioned above?

This includes new assets, name changes, address changes, additional properties, acquisitions, etc.

Upload relevant files below.

Reminder do not to write on original documents. Hand write notes on a separate paper for us to make needed changes. Feel free to upload picture of notes here should you want to.

File

Max. file size: 100 MB.

CCP Changes Request Form