Making and Estate Plan: Estate Planning Intake Questionnaire

Disclaimer

This form is for the purposes of finding out information that may be necessary when consulting with a lawyer. This is only a guide and may not necessarily be the actual form used by your attorney. However, the information asked herein are basic questions that you need to be prepared to answer during your first meeting with your estate planning lawyer.

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MAKING AN ESTATE PLAN

INTAKE QUESTIONNAIRE:  Meeting With Estate Planning Attorney

 It is highly recommended to seek the assistance and guidance of a lawyer who is experienced in estate planning laws for them to be able to guide you through the making of an estate plan. For your attorney to do their job as best they could for you, they need information regarding you and your assets. Be prepared to provide your lawyer with the following information, wherever applicable:

NAMES AND ADDRESSES

Name(s): _______________________________________    Date of Birth:_____________

_______________________________________    Date of Birth:_____________

Mailing Address: __________________________________________________________

__________________________________________________________

Telephone Nos.: (Work) ______________________ (Home) ______________________

(Mobile) _____________________

E-mail Address: ____________________________

ESTATE PLAN

Do you have an existing Will(s) ?    [   ] Yes    [   ] No

(If yes, provide your attorney with a copy)

FAMILY INFORMATION

Marital Status:

[   ] Husband and Wife

[   ] Unmarried, Widow or Widower

[   ] Unmarried, Divorced

[   ] Married Person Establishing Separate Trust

Children:

Indicate Whether Adopted

Name    Date of Birth or from a Previous Marriage

__________________     _________ ______________________________

__________________     _________ ______________________________

__________________     _________ ______________________________

__________________     _________ ______________________________

Any deceased children?    [   ] Yes [   ] No

If Yes, Name of Deceased Child: _________________________________

Did this deceased child leave any children?   [   ] Yes    [   ] No

Name of Deceased Child: _________________________________

Did this deceased child leave any children?   [   ] Yes    [   ] No

Have any children received an advance on their inheritance or are any children financially indebted to you?     Yes     No

Is there any reason to treat your children other than equally? ____________________________________________________________________________________________________________________________________________________________

Are any of the children financially irresponsible? [   ] Yes    [   ] No

Are any of the children under a disability? [   ] Yes    [   ] No

Have you been married previously? [   ] Yes    [   ] No

If any child should predecease a parent, should his/her share pass through to his/her children?      Yes        No

If Yes to the above, please indicate grandchildren, if any:

Parents

Father:  ________________________________________________                              Date of Birth: ___/____/___

Mother: ________________________________________________                              Date of Birth: ___/____/___

In the event of your death, who should be guardian of your minor children?  (a guardian has physical and legal control over your children until they reach the age of eighteen)

First choice:   Name(s):________________________________________________________________

Address:________________________________________________________________

Relationship (if any):______________________________________________________

Second choice:

Name(s):________________________________________________________________

Address:________________________________________________________________

Relationship (if any):______________________________________________________

Other Pertinent Family Information or Explanation of Above Items:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

TRUST

Do you wish to have a trust established for the benefit of your spouse

 Yes     No

and/or children?

 Yes     No

If yes to the above, please indicate who the trustee(s) should be.  (A trustee manages the assets for your children or other beneficiaries until they reach specified ages.  If you do not establish a trust, children inherit at age eighteen.  You may name an individual, bank or trust company, or both.)

First choice:   Name(s):________________________________________________________________

Address:________________________________________________________________

Alternate trustee:

Name(s):________________________________________________________________

Address:________________________________________________________________

Terms of distribution (education, marriage, etc.)_________________________________

Ages(s) for distribution to children from the trust (Ex.: 1/3 at age twenty-one, 1/3 at age twenty-five, 1/3 at age thirty)________________________________________________

PERSONAL REPRESENTATIVE

Who should be Personal Representative (“executor”) of your estate?  (A Personal Representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate.)

First choice (Spouse is normally named first):___________________________________

Alternate:

Name:__________________________________________________________________

Address:________________________________________________________________

Second Alternate:

Name:__________________________________________________________________

Address:________________________________________________________________

SPECIFIC BEQUESTS

Do you wish to make reference in your will to a separate list of any specific bequests of items of personal property that you wish to give to children or others?  The advantage of such a list is that it may be changed without changing your will.      Yes       No

Do you wish to make any charitable bequests?     Yes       No

Do you have a safe deposit box? If so, where?___________________________________

Does anyone else have access to your box?_____________________________________

OTHER ESTATE PLANNING TOOLS

Are you interested in preparing a Power of Attorney granting another person the power to act on your behalf to manage your assets and pay your bills if you become incompetent or unable to sign your name?     Yes       No

Are you interested in preparing a Health Care Declaration (“Living Will”) stating your preference for health care if you are in a terminal condition?     Yes       No

If you are executing a Living Will or Health Care Declaration, please give your primary physician’s name and address:_______________________________________________

________________________________________________________________________

Do you have any special requests regarding funeral or burial instructions or organ donation?  If so, this is best handled by a Letter of Instruction or other statement from your will to your family or other responsible person.     Yes       No

Do you have a financial planner, investment advisor, or insurance agent?

   Yes       No

If Yes to the above, please give name and address:_______________________________

________________________________________________________________________

INFORMATION REGARDING ASSETS

Married Couples:

[   ] Husband has separate assets.

[   ] Wife has separate assets.

[   ] All assets are held jointly.

1. Estimated net worth of estate: $ ____________________

2. Cash or cash equivalent accounts held at financial institutions:

[   ] Checking and savings accounts, or certificates of deposit, with banks, savings and loans, or credit unions.  How many different financial institutions? ________

3. Investments (check all that apply):

[   ] Cash or money fund accounts, or certificates of deposit with stock broker firms.

How many different broker firms? ________

[   ] Stocks, bonds, and mutual funds where your broker holds the certificates and sends you periodic statements showing your account balance.

How many different stock brokerage firms? ________

[   ] Mutual funds where you deal directly with the issuing company rather than through your stock broker.  How many different mutual fund companies? _______

[   ] Stocks and bonds (other than U.S. Savings Bonds) where you hold the certificates in your possession.  How many different companies/issuers? ________

[   ] U.S. Savings Bonds.

[   ] Treasury bills or other government securities.

[   ] Limited partnerships.   How many limited partnerships? ________

[   ] Oil and gas royalty or working interests. How many? ________

[   ] Oil and gas mineral rights in land. How many parcels of land? _________

[   ] Other securities [describe] ______________________________________

____________________________________________________________

4. Retirement plans:

[   ] Individual retirement accounts (IRAs), Keogh, or other individual plans providing tax deferment for deposits and income.

How many different financial institutions hold IRA accounts for: Husband  _____ Wife  _____

[   ] Employer provided profit sharing, retirement, or other benefit plans:

How many different plans for: Husband  ______ Wife  ______

5. Complete this section if you own real estate.

[   ] Personal residence located in state of _______________________

[   ] Other property. How many different parcels of real estate do you own, other than your personal residence?_________

In what state(s) are these parcels located?_________________

Are you purchasing any of the above properties on a contract for deed?

[   ] Yes   [   ] No. If Yes, provide details:_______________________

__________________________________________________________________

__________________________________________________________________

6. Complete this section if you are engaged in business.

Do you own a business, or are you a partner in a business?  [   ] Yes  [   ] No

  If Yes, complete the following:

[   ] Business is organized as a corporation. How many corporations? _______

How many corporations are subchapter S corporations?_______

[   ] Business is organized as a partnership. How many partnerships? _______

[   ] Business is a sole proprietorship. How many different firms? _______

7. Receivables:  If any money is owed to you, as payments on contracts, where you have sold a business, as payments on obligations secured by real estate, or where you have loaned money to someone and you hold a note, indicate each type of indebtedness that you hold.

[   ] Promissory note(s) secured by real estate.  Amount(s) owed:___________

[   ] Installment contract(s) of sale of personal property.

Amount(s) owed:____________

[   ] Unsecured promissory note(s).  Amount(s) owed:_____________

8. Life Insurance Policies:  Please indicate the name of the person insured, the name of the insurance company, the face amount of the policy, and the type of policy.

Name of Insured       Insurance Company         Face Amount Type of Policy

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

9. Annuities: Please indicate the name of the annuitant and the type of annuity.  Do not list annuities under which no benefits are payable after the death of the annuitant.

Regular annuities payable for guaranteed minimum term or amount: ____________________________________________________________________________________________________________________________________

Tax deferred annuities: __________________________________________________________________

__________________________________________________________________

10. Personal property other than automobiles, trucks, boats, and trailers:

[   ] Household furniture and appliances

[   ] Collections, art, antiques, valuable jewelry

[   ] Automobiles

[   ] Boats

[   ] Recreational vehicles

[   ] Motor home

[   ] Business machinery and equipment

[   ] Personal equipment and tools

[   ] Farm or ranch machinery and equipment (other than general household tools)

[   ] Livestock

QUESTIONS

(Make a list of other important questions you may want to ask your lawyer)

Would you like to discuss your legal matter?

PHONE

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Call us or use the email form and we will follow up with you right away.

EMAIL

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