Estate Planning Questionnaire

Estate Planning Questionnaire

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Personal Information

Client #1 Full Legal Name*
U.S. Citizen?*
Client #2 Full Legal Name
U.S. Citizen?

Advisors

Accountant
Name
Telephone
Email
 
Financial Advisor
Name
Telephone
Email
 
Life Insurance Agent
Name
Telephone
Email
 

Important Family Questions

(Please check “Yes” or “No” for your answer)
Are you receiving Social Security, disability, or other governmental benefits?
Are you making payments pursuant to a divorce or property settlement order?
Have you been widowed? If a federal estate tax return or a state death tax return was filed, please furnish a copy.
Have you ever filed federal or state gift tax returns? Please furnish copies of these returns.
Have completed previous will, trust, or estate planning? Please furnish copies of these documents.
Do you support any charitable organizations now that you wish to make provisions for at the time of your death?
Are you currently the beneficiary of anyone else's trust?
Do any of your children have special educational, medical, or physical needs?
Do any of your children receive governmental support or benefits?
Do you provide primary or other major financial support to adult children or others?

Children

Use full legal name.
Child #1
First
Middle
Last
Birthdate
Relationship
 
Do any of your children have special needs or circumstances?
Do you have any deceased children?

Property

Real estate: type any interest in real estate including your family residence, vacation home, time share, vacant land, etc. Please add additional properties by clicking the + button.
Address & APN
Owner
Market Value
Loan Balance
 
Are you the only owner of the properties?

Bank Accounts

Type: checking account “CK”, savings account “SV”, certificates of deposit “CD”, money market “MM” (indicate type below). Do not include qualified accounts (tax deferred) here. Add additional accounts by clicking the + button.
Name of Institution
Type
Owner
Amount
 
Enter the approximate total balance.

Stocks and Bonds

List any and all stocks and bonds you own. If held in brokerage accounts, lump them together under each account. (indicate type below) For owner list which spouse owns the account. If you have more list them in the section below. Add additional accounts by clicking the + button.
Stocks, Bonds or Investment Accounts
Type
Owner
Amount
 

Life Insurance Policies and Annuities

Type: Term, whole life, split dollar, group life, annuity. Additional Information: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.
Company Name & Type of Insurance/Annuity
Amount
Beneficiary
 

Do you have long term care?
If you checked no, would you like more information regarding the importance of long term care?

Retirement Plans

Additional Information: describe the type of plan, the plan name, the current value of the plan, and any other pertinent information. This includes qualified annuities.
Account Type (IRA, 401k, 403b, etc.)
Market Value
Owner
 

Money Owed to You

Type: mortgages or promissory notes payable to you, or other monies owed to you.
Name of Debtor
Date of Note
Maturity Date
Owed to
Current Balance
 

Anticipated Inheritance, Gift, or Lawsuit Judgment

Include gifts or inheritances that you expect to receive at some point in the future; or monies that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

Business Interests

Include general and limited partnerships, sole proprietorships, privately owned corporations, professional corporations, energy interests, and farm and ranch interests. Provide a description of your ownership interests (%) and estimated value of such interests.

Other Assets

Other assets are any property that you have that does not fit into any listed category. By way of example, if you have any intellectual property (patents, trademarks), licensing deals, royalties, oil or mineral rights, etc., than list them below.
Type
Owner
Value
 

Summary of Values

Part III. Design Information

Name Successor Trustees: If you are unable to manage your affairs for financial purposes due to illness or disability, who do you trust to make these decisions? The people listed below will be your agents for Power of Attorney and your nomination of conservator. You and your spouse are the settlor(s)/trustor(s) and trustee(s) of your own trust. This allows you control of your assets prior to incapacitation or death.
Name Successor Trustees
Name
Age
Address
Phone
Relationship
 
Click the + button to add trustees.

General Distribution

Who do you want to receive your estate (money & property) after your death?
Select one:
List
Beneficiary's Name
Relationship
Share
 
If you choose other, list your beneficiaries above. Use the + to add beneficiaries.
At what age would you like your child(ren)/beneficiary to receive their share of your estate?
If one of your beneficiary dies before you do, to who would you give the deceased's share?

Specific Gifts: list any gifts of real estate or cash gifts you wish to make to either individuals or charities.

List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities.
List
Individual or Charity
Amount
 
Use the + to add beneficiaries.

Guardian for Minor Children

If you have any children under the age of 18, please fill out the nomination of guardian for your minor child. Please check yes if they are the same as the successor trustees:
Guardians same as trustees?
If no, please name below:
Name and Address
Relationship/Age
 

Burial Instructions

Client #1
Client #2

Health Care Directives

If you were unable to make health care decisions for yourself, who would you want to speak for you and make those decisions? If you would like the same as your “successor trustee/executors” check the box below. If you would like to choose different agents, please list below.
Client #1
Please check yes if they are the same as the successor trustees.
Client #1 Agent(s):
Name
Age
Address
Phone
Relationship
 
Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Do you want to provide that your organs and tissues should be made available for transplant purposes?
Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a a personal residence rather than a nursing home?
Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?
Client #2 Agent(s):
Name
Age
Address
Phone
Relationship
 
Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Do you want to provide that your organs and tissues should be made available for transplant purposes?
Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a a personal residence rather than a nursing home?
Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?

Other Items

Your estate plan should address all of your hopes, fears, and wishes. Please list any other items you want included or want to discuss:

Certification

I hereby state that the information provided herein is true and correct to the best of my knowledge.
MM slash DD slash YYYY
Name
MM slash DD slash YYYY
Name