Estate Planning Questionnaire

The information in this questionnaire will be used by the attorneys to assist in your estate planning. Please fill out the form as best you can. Any information not filled out prior to submission can be discussed at your initial meeting with the attorney.

Click here to download a PDF version of the form.

I. Family Information

Full Name *

Preferred Name

Address

Apt, suite, etc.

Country

City

State

Zip code

Date of Birth *

SSN *

County *

Email *

Phone *

Single

Married

Divorced

Widow(er)

Spouse Full Name (if applicable)

Preferred Name

Address (if different from above)

Apt, suite, etc.

Country

City

State

Zip code

Date of Birth

SSN

County

Phone

Children (if applicable)

Name

Date of Birth

Spouse Name

No. and Ages of Children

Are any children or grandchildren adopted? If yes, specify

Are any of the children listed above not the children of you and your current spouse? If yes, specify

Do any children/grandchildren have a disability? If yes, specify

Parents

Name of Living Parents

Address(es)

Phone Number(s)

Name of Spouse’s Living Parents

Address(es)

Phone Number(s)

Marriages

Have you been previously married? If yes, how was it terminated (i.e. death, divorce, annulment)?

Has your spouse been previously married? If yes, how was it terminated (i.e. death, divorce, annulment)?

Do you and your current spouse have a prenuptial agreement? If yes, please provide.

Have you resided in a community property state while married? (AZ, CA, ID, LA, NM, NV, TX, WI, WA)

II. Asset Information

Bank Accounts

Name of Institution

Type of Account (Checking/Savings/Money Market/CD)

Ownership (Joint?)

POD Beneficiaries

Average Balance

Brokerage Accounts

Name of Institution

Ownership (Joint?)

TOD Beneficiaries

Current Balance

Additional Stocks and Bonds (include: type, # of shares or face amount of bond, name of company, ownership, and fair market value)

Collections: Do you have any collections? If yes, provide details and approximate value.

Real Estate

Address

Ownership (Joint?)

Approximate Value

Outstanding Debt

Life Insurance

Type (Term, whole etc.)

Company

Amount

Beneficiaries

Business Interests

Name of Entity

Type of Entity

Ownership %

Approximate Value

Retirement Plans

Type

Name of Institution

Approximate Value

Beneficiaries

Automobiles/Boats/Motorcycles etc.

Type

Make/Model

Ownership

Approximate Value

Estates/Trusts: Are you a beneficiary under any estate or trust or do you have the right to direct payment under a trust? If yes, provide details.

Expected Inheritances: Do you expect to inherit any substantial amount of property from anyone? If so, please provide details and approximate amount.

Additional Debts: Do you have any additional debts of substance? If so, include the amount of debt and creditor.

Lifetime Gifts: Have you made any gifts of $15,000 or more in any one year to one person? If so, provide the amount, the year, and whether you filed a gift tax return.

III. Planning Decisions:

Personal Representative: A Personal Representative is in charge of managing the affairs of your estate including the probate administration process after your death.

Name of Personal Representative(s)

Address

Name of Alternate Personal Representative(s)

Address

Guardian: If you are not survived by a parent of your child(ren), you may name one or more guardians for your minor or disabled children.

Name

Address

Primary Guardian

Alternate Guardian

Minors/Young Adults

Do you wish to establish a trust for your children/grandchildren to hold and manage their assets until they reach an age designated by you?

If yes, until what age(s)?

If yes above, please designate a Trustee:

Name

Address

Primary Trustee(s)

Alternate Trustee(s)

Are you the custodian of any minor accounts (UGMA/UTMA)? If yes, provide details.

Have you established any 529 accounts for relatives? If yes, provide details.

Special Needs: Do you have any beneficiaries that have a disability or special needs? If yes, provide details.

Living Trust: Are you interested in a Living (Revocable) Trust?

Durable Power of Attorney: A durable power of attorney allows you to appoint an agent to manage your wellbeing and financial affairs during your lifetime.

Do you currently have a Durable Power of Attorney? If yes, have you recorded it?

If no, please give the name and addresses of your selected agent(s).

Name

Address

Primary Agent

Alternate Agent

If you selected Make a Gift above, to whom?

Healthcare Power of Attorney: A healthcare power of attorney allows you to designate someone to make healthcare decisions when you are incapacitated. Give the name and address and phone number(s) of your selected agents.

Name

Address

Phone Number(s)

Primary Agent

Alternate Agent