Estate Planning Information

Transcription

1 Estate Planning Information Today's Date: I. Personal Information Your Name Country: Work Phone: Cell Phone: Soc. Sec. #: Birth Date: U.S. Citizen?: Yes No Employer: Marital Status: Spouse, Partner, or Significant Other Country: Work Phone: Cell Phone: Soc. Sec. #: Birth Date: U.S. Citizen?: Yes No Employer: 1 of 10

2 II. Children No. of Children: (Please circle) Names of Child's Children: Work Phone Soc. Sec. #: Cell Phone: Birth Date: Spouse, Partner, or Significant Other : No. of Children: (Please circle) Names of Child's Children: Work Phone: Soc. Sec. #: Cell Phone: Birth Date: Spouse, Partner, or Significant Other : No. of Children: (Please circle) Names of Child's Children: 2 of 10

3 Work Phone: Soc. Sec. #: Cell Phone: Birth Date: Spouse, Partner, or Significant Other : No. of Children: (Please circle) Names of Child's Children: Work Phone: Soc. Sec. #: Cell Phone: Birth Date: Spouse, Partner, or Significant Other : Do any of your children have special needs? If so, please describe: III. Deceased Children: Please provide information regarding deceased children, if any Is this person survived by children?: Yes (Please Circle) No 3 of 10

4 Is this person survived by children?: Yes No (Please Circle) IV. Parents/Siblings: Please provide information regarding your parents and siblings 4 of 10

5 V. Agents: Please list some ideas you might have of whom you might like to serve as personal Address: Phone No.: Address: Phone No.: Address: Phone No.: Address: Phone No.: representative, trustee, health care representative, guardian of minor children, etc. VI. Assets and Liabilities 1. What is the estimated value of your estate? 2. Do you have a safety deposit box? If so, where is it located? 3. Real Estate: 5 of 10

6 Property Address: Ownership (Please indicate if jointly held): Mortgage Balance: Purchase Price: Property Address: Ownership (Please indicate if jointly held): Mortgage Balance: Purchase Price: VII. Bank Accounts VIII. Investment Accounts (Non-Retirement) 6 of 10

7 IX. Other Securities (Non-Retirement): Please list any bonds, mutual funds, stocks, or other securities that you own and that have not already been included in the accounts listed above Company/Issuer: Quantity: Ownership (Please indicate joint owner or payable on death beneficiary): Company/Issuer: Quantity: Ownership (Please indicate joint owner or payable on death beneficiary): 7 of 10

8 Company/Issuer: Quantity: Ownership (Please indicate joint owner or payable on death beneficiary): Company/Issuer: Quantity: Ownership (Please indicate joint owner or payable on death beneficiary): X. Life Insurance/Annuities Company: Owner/Insured: Beneficiary Designation: Contingent Beneficiary (if any): Death Benefit: Company: Owner/Insured: Beneficiary Designation: Contingent Beneficiary (if any): Death Benefit: XI. Retirement Accounts: Please list any annuities, IRAs, profit sharing plans, Keogh plans, Pension plans, or other deferred compensation arrangements Retirement Account/Plan: Owner: Beneficiary Designation: Contingent Beneficiary (if any): 8 of 10

9 Retirement Account/Plan: Owner: Beneficiary Designation: Contingent Beneficiary (if any): Retirement Account/Plan: Owner: Beneficiary Designation: Contingent Beneficiary (if any): XII. Business Interests: Please list any interest that you have in any closely-held business entity Business Name and Type (Corp, Pship, LLP, LLC, etc.): Ownership/% of ownership: Basis: Buy/Sell or Other Operating Agreement: XIII. Personal Property: Please list any significant item of personal property such as an automobile, boat, recreational vehicle, artwork, jewelry, collections, etc., below Item: Ownership: 9 of 10

10 Item: Ownership: Item: Ownership: How were you referred to this office: Referred by: Friend: Attorney: The Bee: Other: 10 of 10