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Estate Planning Questionnaire

This form has most of the information we need to help create your estate plan. Fill out this form, and we’ll contact you to set up an appointment after we receive it.

"*" indicates required fields

Step 1 of 5

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Client #1's Legal Name*

Other Names used by Client #1

Address

City

State

Zip Code

County

Phone (home)*

Phone (work)

Phone (cell)

Date of Birth

Month

Day

Year

US Citizen? (Client #1)

Yes

If no, what nationality

Business/Employment

Client #2

Add Client #2

Client #2's Legal Name

Other Names used by Client #2

Client #2's Email

Client #2's Phone

Date of Birth

Month

Day

Year

Business/Employment

US Citizen? (Client #2)

Yes

If no, what nationality

Children of This Marriage (if married)

NAME

AGE or DOB

Click the plus sign to add an additional row for each child.

Number of grandchildren

Range of Ages

Children from Prior Marriage

Name

Client #1 or #2

Age

Treat all children as if they were children of this marriage?

Yes

Any deceased children?

Yes

If yes, name(s)

If yes, survived by issue?

Yes

Do any of your beneficiaries have a learning disability, special educational, medical, or physical needs?

Yes

Do you have any relatives (other than children) who depend on you for all or part of their support?

Yes

Do you think any of your beneficiaries have special problems with spouses, drugs, alcohol or handling money?

Yes

Do you wish to disinherit any of your children, grandchildren or any other close relative?

Yes

Do you have an existing Marital Property Agreement?

Yes

Do either of you expect to inherit substantial assets ($100,000+)?

Yes

Do you have existing Wills?

Yes

Do you have any existing trusts?

Yes

Have you ever filed a Federal Gift Tax Return?

Yes

Should the surviving spouse have the power to control the distribution of the entire estate after the first death?

Yes

Do you want any assets to pass to your children before the second spouse's death?

Yes

If a beneficiary dies prior to the second spouse's death, do you want the assets to go to that beneficiary's issue?

Yes

Do you want assets passing to your beneficiaries to be held in trust until a specific age or ages?

Yes

Trustee/Executor

The name of the person(s) other than the surviving spouse that you want to be the decision maker concerning your estate upon your death.

Guardian

The name of the person(s) that you want to raise a child that is under 18, if both spouses die (if applicable):

Health Care Agent

The name of the person(s) other than the surviving spouse that you want to make any major medical decisions on your behalf:

In general, state how you want your estate distributed among your beneficiaries after the death of both of you?

Name of Charities to Designate

(for example: LDS Church, Children's Justice Center, The Family Place)

Power of Attorney

Who do you want to be your power of attorney over financial affairs while you are living?

Do you want this power effective IMMEDIATELY or only upon your INCAPACITY?

State any specific concerns (not already mentioned) that you have regarding the distribution of your estate:

Burial Wishes

Client #1:

At my death, I wish to be:

cremated

burried

If cremation, I would like my ashes disposed as follows:

If buried, I would like my remains interred as follows:

I have already made arrangements at:

Client #2:

At my death, I wish to be:

cremated

burried

If cremation, I would like my ashes disposed as follows:

If buried, I would like my remains interred as follows:

I have already made arrangements at:

Estimated Value of Estate

Type of Asset:

Client #1's Sep. Prop

Client #2's Sep. Prop

Community Property

Real Estate

(fair market value, less loans)

Real Estate Client #1

Real Estate Client #2

Real Estate Community Property

Securities

(stocks, bonds, mutual funds)

Securities Client #1

Securities Client #2

Securities Community Property

Cash Type Assets

(cash, annuities, notes due you)

Cash Type Assets Client #1

Cash Type Assets Client #2

Cash Type Assets Client Community Property

Business Interests

(sole proprietorship, partnerships, closely held corporation, etc.)

Business Interests Client #1

Business Interests Client #2

Business Interests Community Property

Retirement Plans

(IRA, 401k, etc.†)

Retirement Plans Client #1

Retirement Plans Client #2

Retirement Plans Community Property

Vehicles

(autos, R.V., boat)

Vehicles Client #1

Vehicles Client #2

Vehicles Community Property

Personal Property

(jewelry, furniture, antiques)

Personal Property Client #1

Personal Property Client #2

Personal Property Community Property

* Use best guess; this can be a “ballpark” estimate.

† Do not show benefits which will terminate at death (e.g., pension, social security, etc.).

Life Insurance

(do not include accidental death policies)

"Insured" will be "H" Client #1; "W" Client #2; or "S" survivor
"Owner" will be "C" community property; "H" Client #1 or "W" Client #2
"Cash Value" use best estimate (term policies normally have no cash value)
"Face Value" is the amount payable at death
"Beneficiary" will be "H" Client #1; "W" Client #2; "C" child, "O" other

Life Insurance

Insured (H/W/S)

Owner (H/W/C)

Cash Value ($ estimate)

Face Value ($ paid on death)

Beneficiary (H/W/C/O)

Names/Phone #'s of Professionals

Name of Life Insurance Professional

Phone of Life Insurance Professional

Name of Health Insurance Professional

Phone of Health Insurance Professional

Name of Auto Insurance Professional

Phone of Auto Insurance Professional

Name of Home Insurance Professional

Phone of Home Insurance Professional

Financial Advisor

Accountant