ESTATE PLANNING INFORMATION FORM

Transcription

1 ESTATE PLANNING INFORMATION FORM Please complete this form to the best of your ability. Date: Please bring copies of previous estate planning documents (Will, Trust, Advance Directive, Power of Attorney, etc.), if any. Marital Status: Home phone: Work phone: Occupation: Place of Birth: SSN: Vet ID No.: Union: Local No.: Work phone: Occupation: Place of Birth: SSN: Vet ID No.: Union: Local No.: Date and Place (city, state) of this marriage: Do you have a Premarital or Post-Marital Agreement in effect? Has your current spouse previously been: Married Widowed? If YES, Date of prior Divorce/Death: Former Marriage(s) (if applicable): Former Spouse SSN of Former Date of Marriage: Date of Divorce: Date of Spouse's Death: Please provide a copy of your premarital, post-marital and/or dissolution of marriage documents, if applicable. Estate Planning Information Form Page 1 of 7

2 FAMILY INFORMATION Child 1: M/F 1. Child 2: M/F 2. Child 3: M/F Child 4: M/F 4. Estate Planning Information Form Page 2 of 7

3 Important Family Questions: 1. Do you have a child with a learning disability? 2. Does anyone in your family receive public support or benefits? Do you have any adopted children? 4. Do any of your children have special physical needs? 5. Are any of your children institutionalized? 6. Are you or your spouse receiving social security, disability, or other public benefits? 7. Do you provide primary or major financial support to adult children? 8. Are you or your spouse making payments pursuant to a divorce or property settlement agreement? 9. Have you lived in other states while married to your current spouse? 10. Have you or your spouse ever filed federal or state gift tax returns? If YES, please bring copies of these returns 11. Are both you and your spouse US citizens? If NO, what is your citizenship status? ASSETS Home: Address Mortgage balance: Furniture Other Real Property: 1. Address (location) 2. Address (location) Address (location) Mortgage Mortgage Mortgage Stocks, Bonds, Mutual Funds or other financial investments: Name/Location Account No. Owner(s) Value Estate Planning Information Form Page 3 of 7

4 Bank Accounts: Money Market CD's Checking Bank/Branch Account No. Owner(s) Amount Savings Other Annual Income: Spouse's: Retirement Benefits (Including IRA's): Name of Investment Owner Beneficiary Present Value if any Safe Deposit Box: Number: Name of Institution: Branch: Box No. Ownership: H/ W/ Both Others listed on box: Relationship: Phone: Business Interests (how held and controlled): Partnership: Corporation: Sole Proprietorship: LLC: Other: Collections (coins, stamps, etc.): Life Insurance: Company Owner Beneficiary Alternate Death Benefit Estate Planning Information Form Page 4 of 7

5 Automobiles and machinery: Jewelry: Expected Inheritance: Amount Trusts: Are you serving as a trustee? or the beneficiary of a trust? Or are you a grantor for a trust?. If YES to any of the above, please describe: Other Assets Not Listed Above: Description Owner Value Estate Summary (for Office Use): Client 1 Client 2 Joint Real Estate $ $ $ Stocks, Bonds, etc. $ $ $ Bank Accounts $ $ $ Retirement Ben. $ $ $ Business Interests $ $ $ Collections $ $ $ Life Insurance $ $ $ Automobiles $ $ $ Jewelry $ $ $ Miscellaneous $ $ $ Other $ $ $ Total $ $ $ Estate Planning Information Form Page 5 of 7

6 DISTRIBUTION Please describe how you want to distribute your property at death. Specific Gifts: Recipient Relationship to You Gift/Amount Residue (Everything Else): Do you want any heir to not inherit anything? If so, please (briefly) explain why: Personal Representative/Trustee: Guardian: Conservator: Agent for Power of Attorney (if desired): AGENTS Health Care Representative (if an Advance Directive is desired): Phone Number: Phone Number: Estate Planning Information Form Page 6 of 7

7 Do you want to give specific directions about your funeral arrangements? If YES, please describe: Special Notes or Instructions: Do you want more information on any of the following subjects? Power of Attorney: Advance Directive: International Will Certificate: Organ Donor Information: Living Trust: Estate Planning Information Form Page 7 of 7