Information for Estate Planning
(If not married just fill in for Client and indicate not married)
(Continue on back of each sheet where necessary)
GENERAL INFORMATION
Full Name of Client :________________________________ Birthdate _________
Occupation:_________________________ Social Sec#_______________
Citizenship:_________________________
Full Name of Spouse:________________________________ Birthdate _________
Occupation:__________________________ Social Sec#______________
Citizenship: __________________________
Address: ___________________________________________________________
Telephone #s: Home____________ Work (H)_____________ (W) ________________
Fax(H)__________ (W)__________ Beeper/Cell (H) ____________(W)______________
Email addresses: (H) _______________________; (W) __________________________
CHILDREN: (indicate if adopted or who is the parent if child is not from current marriage; please also add any particularly pertinent information regarding the child on the back of this sheet )
Name Birthdate Address/Phone
1.
2.
3.
4.
OTHER DEPENDENTS (such as parents) : Name, relationship, type of dependency (please also indicate the age, health and financial situation of your respective parents and whether they will need to qualify for government benefits?
GRANDCHILDREN: Indicate #of child listed above, name of spouse, and names and birthdates of their children:
SPECIAL NEEDS: Please explain if any family member or dependent requires special medical, educational or other care:
PRIOR MARRIAGES: Please indicate name of previous spouse, how and when marriage terminated and existence of any alimony or child support payments.
MEDICAL ISSUES: Already have living wills yes ______ no ______
ANATOMICAL GIFTS: Client yes______ no ______ Spouse yes______ no_______
NUTRITION/HYDRATION
if terminal illness: Client yes ____ no______ Spouse yes_______ no______
SURROGATE to make health care decisions- name, relationship, address, telephone:
FOR CLIENT: ________________________________________________________
alternate ________________________________________________________
FOR SPOUSE _________________________________________________________
alternate _________________________________________________________
POWERS OF ATTORNEY Do you have copies? ______; Need to prepare ______
CLIENT’S AGENT: _______________________________ Tel. ________________
address _______________________________________________________
SPOUSE’S AGENT: _______________________________ Tel. _________________
address ________________________________________________________
DOMICILE ISSUES:
2nd home address, if any: ___________________________________________________
Please indicate the amount of time spent there each year and where registered to vote
FAMILY ADVISORS:
Accountant: _________________________ Tel. ___________________
Stock Broker: _______________________ Tel. ___________________
Insurance Agent: ____________________ Tel.___________________
Other Advisor: ______________________ Tel. __________________
PRE OR POST MARITAL AGREEMENT Yes ___ No ____ Copy attached ____
EXISTING WILLS: Husband: Yes ______ Copy attached _______
Wife: Yes ______ Copy attached _______
EXISTING SEPARATE STATEMENTS RE TANGIBLE PERSONAL PROPERTY: Husband: Yes ____ No ____; Wife Yes ____ No _____
EXISTING TRUSTS:
Husband: Revocable: Yes _____ Copy attached _______
Irrevocable: Yes _____ Copy attached _______
Retirement Trust Yes ______ Copy attached _______
Wife: Revocable: Yes _____ Copy attached _______
Irrevocable: Yes _____ Copy attached _______
Retirement Trust Yes ______ Copy attached _______
PERSONAL REPRESENTATIVES (appointed to administer estate if probated):
Husband's: First Set: _____________________________________________
Second Set _____________________________________________
Wife: First Set: _____________________________________________
Second Set _____________________________________________
TRUSTEES of Existing Trusts (if more than one, please identify trust and add to back of sheet) :
Husband's: First Set: _____________________________________________
Second Set _____________________________________________
Wife: First Set: _____________________________________________
Second Set _____________________________________________
GUARDIANS FOR MINORS (if any):
First Set: _____________________________________________
Second Set: _____________________________________________
COMPUTER INFORMATION: Directions regarding information stored on personal computers, locations of passwords, etc:
EXISTING BUSINESS AGREEMENTS THAT IMPACT ESTATE PLANNING:
1. Copy Attached ______
2. Copy Attached ______
3. Copy Attached ______
YOUR CONCERNS OR GOALS REGARDING ESTATE PLANNING
HUSBAND:
WIFE:
ASSET INFORMATION:
The manner in which property is held (jointly, individually, in trust, or subject to a contractual beneficiary designation) will determine whether it passes automatically to certain persons at death or whether it is subject to the terms of an existing will or trust or if it will pass according to statutory direction, in the absence of a will.
Therefore, it is important to be accurate concerning the exact ownership of an asset and the exact contractual beneficiary, if any- such as the life insurance beneficiary or retirement account beneficiary or the beneficiary of an “in trust for” account.
Please indicate ownership by placing approximate current value of asset in column labeled “HUSBAND, WIFE, or JOINT”. Please indicate the contractual beneficiary, if any.
If more space is needed, please show "continued" and add to back of sheet.
TANGIBLE PROPERTY HUSBAND WIFE JOINT
Motor vehicles (Boats, cars, airplanes) ________ ________ ________
Personal possessions (jewelry etc.) ________ ________ ________
Furniture ________ ________ ________
Collections (coins, art, etc.) ________ ________ ________
Other ________ ________ ________
BANK ACCOUNTS
Type of Account Beneficiary?
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
BANK ACCOUNTS (cont). HUSBAND WIFE JOINT
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
SECURITIES (Stocks/bonds/mutual funds,etc.)
or Investment Accounts)
Company ______________________ _________ _________ _________
Company _____________________ _________ _________ _________
Company _____________________ _________ _________ _________
Company ___________________ _________ _________ _________
Company ___________________ _________ _________ _________
Company ___________________ _________ _________ _________
OTHER INTANGIBLE PROPERTY (i.e. accounts receivable; mortgages payable
to client or spouse)
___________________________ ________ ________ ________
___________________________ ________ ________ ________
___________________________ ________ ________ ________
REAL ESTATE - list fair market value with mortgage in ( )
Location and brief description
___________________________ ________ ________ ________
___________________________
___________________________ ________ ________ ________
___________________________
___________________________ ________ ________ ________
___________________________
BUSINESS INTERESTS HUSBAND WIFE JOINT
Name and form (partnership, corporation- type,
proprietorship, )
___________________________ ________ ________ ________
___________________________
___________________________ ________ ________ ________
___________________________
___________________________ ________ ________ ________
___________________________
RETIREMENT ASSETS
________________________________ ________ ________ ________
________________________________ ________ ________ ________
________________________________ ________ ________ ________
________________________________ ________ ________ ________
________________________________ ________ ________ ________
________________________________ ________ ________ ________
Is either party taking distributions? Yes ______ Yes ______
BENEFICIAL INTERESTS IN TRUSTS
Description of interest (life interest, remainder)
________________________________ _________ _________ _________
________________________________ _________ _________ _________
POWERS OF APPOINTMENT
OVER TRUST OR OTHER PROPERTY
________________________________ _________ _________ _________
________________________________ _________ _________ _________
EXPECTED INHERITANCES
From whom:
________________________________ _________ _________ _________
________________________________ _________ _________ _________
GIFTS MADE IN PAST
Amount To whom By whom Date Gift tax return filed?
LIFE INSURANCE OR ANNUITIES
1. Company ____________________ Policy Number _______________Type ____________ Name of Insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy __________
2. Company ____________________ Policy Number ___________Type of policy _________ Name of insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy __________
3. Company ____________________ Policy Number ___________Type of policy _________ Name of insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy __________
4. Company ____________________ Policy Number ___________Type of policy _________ Name of insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy _________
5. Company ____________________ Policy Number ___________Type of policy _________
Name of insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy __________
6 Company ____________________ Policy Number ___________Type of policy__________
Name of insured _________________ Owner _______________________________
Primary Beneficiary: ________________ Secondary Beneficiary: _____________________
Face Value ____________Cash value _________ Outstanding Loans on Policy _________
LIABILITIES (excluding mortgages)
Creditor Debtor Property Securing Debt if any Due Date