Estate Planning Form

Estate Planning Questionnaire

Personal Information

Full Legal Name

Date of Birth

Month

Day

Year

Address

Social Security Number

Contact Information (Phone Number and Email)

Employer, Job Position, Business Phone Number, Annual Income and Retirement/Disability Pay, if any

Health Issues?

If yes, please specify

Military?

If yes, which Branch and Length of Service

Spouse's Information

Full Legal Name

Date of Birth

Month

Day

Year

Address (If Different)

Social Security Number

Contact Information (Phone Number and Email)

Employer, Job Position, Business Phone Number, Annual Income and Retirement/Disability Pay, if any

Health Issues?

If yes, please specify

Military?

If yes, which Branch and Length of Service

Marriage

Date

Month

Day

Year

Place of Marriage

Is this a first marriage?

Yes

Estate Planning Background

Does a prior will exist?

Yes

Location of Will

Where are important papers kept?

Any Professional Individuals/Organizations that Need to be Consulted?

Do you have a life insurance policy?

Yes

Have you pre-planned your memorialization and/or funeral?

Yes

Designation of Individuals to Carry Out Wishes: For this section, please identify the people that you would like to handle your affairs. Please note that if you would like to list your spouse as the first individual for each role, you do not need to list each other and we can discuss that during the consultation.

Power of Attorney (General/Business Affairs): These are the individuals who would handle your business and financial affairs during periods of incapacity or incompetency. They would act during your lifetime.

Primary Power of Attorney - Full Name, Phone Number and Address

Alternate/Second Power of Attorney - Full Name, Phone Number and Address

Health Care Power of Attorney: These are the individuals who would make medical decisions on your behalf when you are mentally or physically unable to do so for yourself. They would act during your lifetime.

Primary Power of Attorney - Full Name, Phone Number and Address

Alternate/Secondary Power of Attorney - Full Name, Phone Number and Address

Will: These are the individuals who will handle your affairs post-mortem and is responsible for filing any documents with the court and going through the probate process.

Executor/Executrix

Alternate Executor/Executrix

Trustee (if applicable): These are the individuals who will distribute money or assets over an extended period of time in accordance with your wishes.

Primary Trustee

Alternate/Secondary Trustee

Guardian (if applicable): These are the individuals who will care for any minor children you may have.

Primary Guardian

Alternate Guardian

Disposition of Poperty

To whom are you leaving your property?

Is there any person that you are intentionally not leaving property to, who may otherwise have a claim to property?

Beneficiaries

Children - For each Child, specify their Full Legal Name, Age, Marital Status and State/Residence

Are any of your children deceased?

Yes

Are any other children expected?

Yes

Are any children handicapped?

Yes

Are any children in poor health?

Yes

Grandchildren - For each Grandchild, specify their Full Legal Name, Age, Marital Status and State/Residence

Parents, Siblings and Other Beneficiaries - For each person, specify their Full Legal Name, Relationship and State/Residence

Charities - Do you desire to leave anything to charity? If so, specify the Full Name of the Organization, Location, Owner/Principal (If Known) and Tax ID (If Known) for each Charity

Presently Owned Property/Assets

Real Estate - For reach property specify the Address, Ownership (i.e. how the property is titled), Date of Purchase, Value at Time of Purchase, Estimated Present Value and the Remaining Balance of Mortgage

Securities (Closely Held, Stock and Bonds) - For each, specify the Name and Type of Security, Account Number and Approximate Present Value

Bank Accounts: Please include all Savings, CDs, and Checking accounts - For each, specify the Name and Type of Account, Account Number, Approximate Present Value and Banking Institution

Automobiles: (Including Cars, Boats, and Trailers) - For each, specify Make and Model, Fair Market Value, Title Owner and Present Liens

Other Assets/Family Heirlooms

Debts/Liabilities

Secured Debt: Please include all debts which are attached to collateral (i.e., a physical item, such as a car) - For each, specify Name and Type of Debt, Lending Institute, Original Amount of Debt and Present Value of Debt

Unsecured Debt: Please include all debts which are not attached to collateral (i.e., student loans) - For each, specify Name and Type of Debt, Lending Institute, Original Amount of Debt and Present Value of Debt

Future Assets

Life Insurance - For each, specify Company, Face Amount, Policy Type, Owner, Beneficiaries and if there is a Loan on Policy

Anticipated Inheritance: Do you or your spouse expect to inherit any substantial property in the future which should be considered in planning your estate?

Yes

From Whom and Approximate Amount?

Pension/Profit-Sharing Benefits: In death or retirement, does your employer make payments to you or your spouse under any qualified pension or profit sharing plan, deferred compensation plan?

Yes

Trust: Are you or your spouse the beneficiary of any trust?

If yes, please specify the Name/Type of Trust

Do you or your spouse have the rights under the will or trust of another person to designate the beneficiaries of property?

Yes

Gifts

Have you made any gifts in excess of $10,000 to any one person in any one year after January 1, 1982? If yes, was a gift tax return filed?

Business Interests

Specify the Name of the Business, Nature and Location of Business, Form of Organization, Nature and Proportion of Testator's Interest in Business, Net worth of testator's interest and Buy-sell agreements that would affect testator's iterest in the business after death.

Long answer

Document Checklist: In certain circumstances, it may be necessary to provide a copy of the following documents. Although it is not necessary to bring any of the documents to the consultation, please note that it may make the process easier to bring anything you have available.

Prior Will, Power of Attorney, Trust, or other Estate Planning Documents
Life Insurance policies, particularly if there is a question as to how the beneficiaries are designated orimpacted by any estate plan
Buy-sell or other business agreements that would affect the testator’s interest in the business after death
Any deeds to which property is owned jointly, or if you wish to gift the property during life
Itemized lists of tangible personal property, including guns, that you would like to be considered duringthe estate planning process