ESTATE PLANNING QUESTIONNAIRE
DATE:
PERSONAL INFORMATION
FULL NAME:_________________________________________________
SOCIAL SECURITY NUMBER:__________ BIRTH DATE:_______________
CITIZENSHIP:______________________ MARITAL STATUS: __________
HOME ADDRESS:______________________________________________
___________________________________________________________
COUNTY OF RESIDENCE: _______________________________________
HOME TELEPHONE: _____________________
HOME FACSIMILE: ______________________
OTHER CONTACT#: ______________________
HOME E-MAIL: _____________________________________
OCCUPATION: _________________________
EMPLOYER: ___________________________
BUSINESS ADDRESS: _________________________________
BUS TELEPHONE: ____________________________
BUS FACSIMILE: ____________________________
OTHER CONTACT#: __________________________
BUSINESS E-MAIL: __________________________
Previously married?: ______ If so, please provide:
(a) Name of former spouse: _________________________
(b) Date on which terminated: ________________________
(c) Manner inwhich the marriage terminated:_________________
(d) Descendant(s) of prior marriage: ________________________
(e) Was there a premarital or postmarital agreement’?_____________
PLEASE PROVIDE A COPY OF ANY DIVORCE DECREE, PREMARITAL AGREEMENT OR POSTMARITAL AGREEMENT.
SPOUSE’S INFORMATION
FULL NAME:_______________________________________
SOCIAL SECURITY NUMBER:____________________ BIRTH DATE:______
CITIZENSHIP: ______________________ MARITAL STATUS:__________
HOME ADDRESS: _____________________________________________
COUNTY OF RESIDENCE:__________________________
HOME TELEPHONE: _____________________________
HOME FACSIMILE: _____________________________
OTHER CONTACT#: _____________________________
HOME E-MAIL: ________________________________
OCCUPATION: ________________________________
EMPLOYER: __________________________________
BUSINESS ADDRESS: _______________________________________
BUS TELEPHONE: ____________________________
BUS FACSIMILE: ____________________________
OTHER CONTACT#: __________________________
BUSINESS E-MAIL: ________________________________________
Previously married?: ______________
If so, please provide:
(a) Name of former spouse: ________________________________
(b) Date on which terminated: _____________________
(e) Manner inwhich the marriage terminated:__________________
(f) Descendant(s) of prior marriage:________________________
(e) Was there a premarital or postmarital agreement’? _____________
PLEASE PROVIDE A COPY OF ANY DIVORCE DECREE, PREMARITAL AGREEMENT OR POSTMARITAL AGREEMENT.
FAMILY MEMBERS
Please list living parents, children and grandchildren or yourself and your spouse. Please also list any other individuals who will be beneficiaries under your estate plans. and any other individuals whom you may consider naming as Executor, Trustee or Guardian. Please indicate whether their relation is to yourself or your spouse, and for Grandchildren please indicate which child is the parent.
NAME RELATION ADDRESS BORN
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
__________ ________ ___________________ _______
Please indicate if any child, grandchild or other potential beneficiary is:
[ ]adopted
[ ]born out of wedlock
[ ]divorced or separated
[ ]physically or mentally handicapped
FINANCIAL INFORNIATION
ASSETS | IN YOUR NAME | IN SPOUSES NAME | IN JOINT NAME | TOTAL |
HOME | ||||
VACATION HOME | ||||
OTHER R.E. (LOCATION) | ||||
CASH ACCOUNTS | ||||
TAX EXEMPT MUNICIPAL BONDS | ||||
OTHER MARKETABLE SECURITIES | ||||
CLOSELY-HELD BUSINESS INTERESTS | ||||
PARTNERSHIP INVESTMENT | ||||
INVESTMENT GEMS & METALS | ||||
LIFE INSURANCE (DEATH BENEFIT) | ||||
VESTED RETIREMENT BENEFITS | ||||
INDIVIDUAL RETIREMENT ACCOUNTS | ||||
VALUABLE COLLECTIONS | ||||
AUTOS & OTHER PERSONAL PROPERTY | ||||
OTHER ASSETS (SPECIFY) | ||||
TOTAL ASSETS |
LIABILITES | OWED BY YOU | OWED BY SPOUSE | OWED JOINTLY | TOTAL |
MORTGAGE ON HOME | ||||
MORTGAGE ON VACATION HOME | ||||
LOANS AND OTHER DEBTS | ||||
TOTAL LIABILITIES |
NET WORTH FOR ESTATE PLANNING:
ASSET CLASSIFICATION
Is home: [ ] House [ ] Condominium [ ] Co-op
Is title in land trust? [ ] Yes [ ] No
Is vacation home: [ ] House [ ] Condominium [ ] Co-op
Is title in land trust? [ ] Yes [ ] No
Is any real estate potentially subject to any environmental concerns of which you are aware?________________________________________________
Total death benefits listed on item 2 above, excluding accidental death benefits._____________________________________________________
Please describe any loans between family members.____________________
____________________________________________________________
Assets, including death benefit from life insurance policies, minus liabilities.
___________________________________________________________
1. Community Property
Have you ever lived in a community property state during-, your marriage (Arizona, California, Idaho, Louisiana. Nevada, New Mexico, Texas, Washington or Wisconsin)? _____ If so please indicate which one(s) and the dates on which you lived there:__________________________________
__________________________________________________________
PLEASE IDENTIFY COMMUNITY PROPERTY SHOWN ABOVE BY PLACING A “C” TO THE RIGHT OF THE APPROPRIATE ENTRY.
2. Life Insurance Policies
COMPANY & POLICY NUMBER | TYPE (GROUP, WHOLE LIFE, etc.) | DEATH BENEFIT | CASH VALUE | LOANS | INSURED | OWNER | BENEFI-CIARY |
3. Joint Property
If any of the property shown above is owned jointly with someone other than your spouse, please indicate the co-owner(s), their respective interests in the property, and who provided the funds to purchase the property. If any of the liabilities shown above are joint liabilities with someone other than your spouse, please indicate the co-obligor(s) and the nature of their respective liabilities.
___________________________________________________________
___________________________________________________________
___________________________________________________________
4. Business Interests
List and briefly describe closely held business interests. Please Indicate the type of’ entity and your interest in the entity.
___________________________________________________________
___________________________________________________________
___________________________________________________________
PLEASE PROVIDE COPIES OF ANY PARTNERSHIP AGREEMENT, SHAREHOLDERS’ AGREEMENT, BUY-SELL AGREEMENT, VOTING TRUST, OR OTHER SIMILAR AGREEMENT.
5. Employee Benefits
Describe any pension or profit-sharing plans applicable to yourself or your spouse. Give the name of the plan; general description of the benefits; the name of the beneficiary; and indicate whether you made any contributions to the plan.
___________________________________________________________
___________________________________________________________
___________________________________________________________
Describe any stock options, deferred compensation and other employee benefits.
___________________________________________________________
___________________________________________________________
___________________________________________________________
PLEASE PROVIDE THE SUMMARY PLAN DESCRIPTION AND LATEST STATEMENT OF BENEFITS PROVIDED BY YOUR RESPECTIVE EMPLOYERS.
6. Individual Retirement Accounts
OWNER | TRUSTEE OR CUSTODIAN | VALUE | BENEFICIARY |
7. Tangible Personal Property
Please describe any tangible personal property requiring special treatment (for example, art objects, collections, boats, horses or antiques).
___________________________________________________________
___________________________________________________________
8. Trusts
Please describe any trust you or your spouse has established, including, the value of the trust assets. Did the trust become irrevocable on or before_____________ , ? If so, were additional contributions made to it after _______________ ______, ________ ?
___________________________________________________________
___________________________________________________________
Please describe any interest that you or any family members have in any trust created by another,_________________________including the value of the trust assets. Did the trust become irrevocable on or before_________ ________, ______ ? If so, were additional contributions made to it after__________ ____ , _______?
PLEASE PROVIDE COPIES OF ANY SUCH TRUST INSTRUMENTS.
9. Children’s Assets
Please describe any property held for your children, such as under a Uniform Transfers to Minors Act.
___________________________________________________________
___________________________________________________________
10. Inheritances
Please describe any property you or your spouse has inherited within the past 10 years.
___________________________________________________________
___________________________________________________________
Please describe any inheritance that you or any member of your family expects to receive in the future.
___________________________________________________________
___________________________________________________________
ADDITIONAL INFORMATION
1. Gifts
Have you ever filed a gift tax return? [ ] Yes [ ] No
Has your spouse ever filed a gift tax return? [ ] Yes [ ] No
Please describe any gifts you or your spouse has made to any person (other than to each other and other than any gifts fully disclosed on a gift-tax return).
PLEASE PROVIDE A COPY OF ALL GIFT TAX RETURNS YOU OR YOUR SPOUSE HAS FILED.
2. Current Estate Planning Documents
______________________________________________________________________________
PLEASE PROVIDE COPIES OF YOUR CURRENT ESTATE PLANNING DOCUMENTS.
3. Family Advisors
NAME | ADDRESS | CONTACT #s | |
YOUR PHYSICIAN | |||
SPOUSE’S PHYSICIAN | |||
ACCOUNTANT | |||
TAX PREPARER | |||
INVESTMENT ADVISOR | |||
INSURANCE | |||
TRUST OFFICER OR BANKER |
4. Safe deposit box
Where is your safe deposit box and who has access to it?
___________________________________________________________
___________________________________________________________
Attorney Specific Forms
–For Attorney Specific Forms you can download in Word format, go to
http://www.uslegalforms.com/forattorneys/