Estate Planning Form

General Information

Married or single? *

Married

Husband's Information

Husband’s Legal Name

Other Names used by Husband

Address

County

Email Address

Telephone

Work Number

Cell Number

Date of birth

Month

Day

Year

US citizen?

If no, what nationality?

Business/Employment

Wife's Information

Wife's Legal Name

Other Names used by Wife

Date of Birth Wife

Month

Day

Year

Business/Employment

US citizen?

If no, what nationality?

Offspring Information

Children of this marriage?

Please list Names, age or date of birth.

Children from prior marriage?

Please list names, age and birth parent name.

Any deceased children?

Please list name

Survived by issue?

Any adopted children?

Please list adopted child name

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

Do you have any grandchildren

Number of grandchildren.

Range of ages.

History

Prior Marriages?

If yes, name of prior spouse.

How Terminated?

Date of death

Month

Day

Year

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

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

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:

Do you have an existing Marital Property Agreement?

Do you have any existing trusts?

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

Do you have existing Wills?

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

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

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

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

Do you wish to make anatomical bequests (organ donor)?

Have you ever filed a Federal Gift Tax Return?

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

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

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

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?

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

Burial Wishes

Husband's burial wishes

At my death, I wish to be:

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

Wife's burial wishes

At my death, I wish to be

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

Use best guess; this can be a “ballpark” estimate. Do not show benefits which will terminate at death (e.g., pension, social security, etc.).

Husband's value of estate

Husband's Real Estate

Husband's Securites

Husband's cash type assets

Husband's business interest

Husband's retirement plans

Husband's vehicles

Husband's personal property

Total husband's value of estate

Wife's value of estate

Wife's Real Estate

Wife's Securities

Wife's cash type assests

Wife's business interest

Wife's retirement plans

Wife's vehicles

Wife's personal property

Total wife's value of estate

Joint value of estate

Joint Property

Joint Securities

Joint cash type assests

Joint business interest

Joint retirement plans

Joint vehicles

Joint personal property

Total joint value of estate

Life Insurance

Dated

Month

Day

Year

We have each read the foregoing material and understand that there are potential conflicts of interest between myself and my spouse in the matters about which we are consulting you. If either of us desire to have separate counsel or desire you not to be involved at all, that spouse shall notify you. We each hereby consent to having you represent both of us in the drafting of our estate planning documents and we each hereby waive any potential or actual conflicts of interest. We understand that since you will be representing both of us on the same matter, as between ourselves and you, there are no confidential communications.

Agree

Yes

I understand by submitting this form I am signing the client information form and that all the information is accurate.

Single

Legal Name

Other Names used

Address

County

Email Address

Telephone

Work Number

Cell Number

Date of Birth

Month

Day

Year

Business/Employer

Marital Status

Name of Spouse

US citizen?

What nationality?

Offspring Information

Children

List childrens name, age or date of birth

Any deceased children?

Name

Survived by issue?

Do you have grandchildren

Number of grandchildren

Range of Ages

History

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

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

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

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

If a named beneficiary dies before you, do you want the assets to go to that beneficiary’s issue?

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

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

Do you have an existing Will?

Have you ever executed a trust (either revocable or irrevocable)?

Have you ever filed a Federal Gift Tax Return?

Do you have an existing General Power of Attorney?

Do you currently hold any assets in Joint Tenancy with another person?

Do you wish to make anatomical bequests (organ donor)?

Do you wish to have a “Living Will”?

The name of the person(s) that you want to be the decision maker concerning your estate upon your death:

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

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

In general, state how you want your estate distributed among your beneficiaries?

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

Burial Wishes

At my death, I wish to be

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

Use best guess; this can be a “ballpark” estimate. Do not show benefits which will terminate at death (e.g., pension, social security, etc.).

Real Estate

Securities

Cash type assets

Business interests

Retirement plans

Vehicles

Personal property

Life Insurance

(do not include accidental death policies) "Cash Value" use best estimate (term policies normally have no cash value), ”Face Value" is the amount payable at death

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