ESTATE PLANNING WORKSHEET

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+ ESTATE PLANNING WORKSHEET THE FIRST STEP TOWARD PREPARING APPROPRIATE ESTATE PLANNING DOCUMENTS SUCH AS WILLS, POWERS OF ATTORNEY AND LIVING WILLS IS TO THOROUGHLY REVIEW YOUR CIRCUMSTANCES, NEEDS AND GOALS. BY TAKING THE TIME TO COMPILE ALL RELEVANT INFORMATION, YOU CAN BE ASSURED THAT YOUR ATTORNEY AND/OR OTHER ESTATE PLANNING CONSULTANTS WILL UNDERSTAND AND HELP YOU ACHIEVE YOUR GOALS. THE ATTACHED ESTATE PLANNING WORKSHEET PROVIDES A STEP-BY-STEP GUIDE FOR THE GATHERING OF RELEVANT INFORMATION, AS WELL AS THE ANALYSIS OF YOUR SPECIFIC NEEDS AND OBJECTIVES. THE LAW OFFICE OF RICHARD D. MEINDERS, P.C. 2002 ROUTE 70, SUITE 2 MANCHESTER, NEW JERSEY 08759 (732) 408-0900 FAX: (732) 408-9277 lawrdm@msn.com

ESTATE PLANNING WORKSHEET The information requested on this worksheet is very important. This information enables us to plan the estate to accomplish future goals and to save on taxes and administrative expenses. For the purpose of our initial consultation you do NOT have to disclose specific account numbers and may estimate account balances and asset values. If you are married and all information on this worksheet is identical for you and your spouse, fill out one worksheet only. If information for each spouse differs, make a copy of this worksheet so each spouse has one to fill out. For those of you who are single, we apologize for phrasing everything based on husband and wife. This is for simplicity of the form only. To fill out forms, please fill in the wife s blanks if you are female and the husband s blanks if you are male. Estate planning is very important for singles as well as couples. Plan of distribution for singles is not obvious and most or all assets will be probated since joint tenancy with a spouse is not an available method of avoiding probate. Date: Email Address: Phone Number: HUSBAND: Date of Birth: FIRST MIDDLE INITIAL LAST WIFE: Date of Birth: FIRST MIDDLE INITIAL LAST ADDRESS: Referred by: Marital Status: Married Divorced Separated Single (including widowed and not remarried) What is your primary motivation for considering estate planning: (Select one or more) Probate Avoidance Concerns about Potential Nursing Home Expenses Business or Farm Planning NJ Estate Tax Planning (for estates over $675,000.00) Federal $5 Million Guardianship for Minor Children Other: How soon would you like to complete planning? Is there a specific deadline, such as an upcoming trip, surgery, etc.?

Husband Wife Do you presently have a will? Yes No Yes No Do you presently have a trust? Yes No Yes No Are you interested in avoiding probate of your estate? Yes No Yes No Were there any previous marriages? Yes No Yes No Are any of your children not from your current Yes No Yes No marriage? Are any of your children or other beneficiaries Yes No Yes No handicapped? Do you own a farm or business? Yes No Yes No If yes, do any of your children work in the Yes No Yes No business with you? If yes, does the child working in the business have an Yes No Yes No ownership interest in the business? Is the need for nursing home care probable in the Yes No Yes No next three years? Is preserving assets from nursing home costs important Yes No Yes No enough to you that you would feel comfortable giving up control of assets to someone else, such as a family member? Do you own a long-term care (nursing home) insurance Yes No Yes No policy? Are there any serious health problems? Yes No Yes No If yes, please describe briefly: Do you hold everything jointly with your spouse, or is some All Joint Some separate property separate? (except IRAs, pensions, etc.) NET WORTH: If you added the value of all property owned by yourself and your spouse including real estate, personal property, bank accounts, stocks, bonds, IRAs, death benefits on life insurance policies, and anything else you own, what is the approximate total value of the estate of yourself and your spouse? What is the total amount of your outstanding liabilities?

TYPE OF ASSET TITLE IN WHICH HELD CURRENT VALUE REAL ESTATE: Personal Residence Vacant Land Other LIQUID ASSETS (Include Account Number and Where Held) Cash on Hand Government and Publicly Traded Securities Unlisted Securities (Not Publicly Traded) Money Market Accounts Equity In Business Sole Prop. Partnership Notes and Loans Receivable

TYPE OF ASSET (Include Acct. Number) Checking Accounts TITLE IN WHICH HELD (Husband sole; Wife sole; Joint with spouse; Joint with third party; Survivorship marital; or Tenants in common, etc.) CURRENT VALUE Savings Accounts Annuities IRAs Pension/Profit Sharing Life Insurance Certificates of Deposit (include renewal date) - List next to boxes. Put an X in box if copy is attached. Automobiles - List next to boxes. Put an X in box if copy is attached. NOTE: JOINTLY HELD ASSETS AND ASSETS THAT HAVE A NAMED BENEFICIARY (SUCH AS LIFE INSURANCE, POD ACCOUNTS, ETC) WILL PASS OUTSIDE OF YOUR WILL!!! Other Personal Property: Other Assets: LIABILITIES: Name Loan Taken In: Amount Owed:

CHILDREN OR OTHER BENEFICIARIES NAME ADDRESS DATE OF BIRTH RELATIONSHIP PLAN OF DISTRIBUTION 1. SPECIFIC GIFTS. Do you want to make charitable gifts, such as to a church or other institution? Do you wish to make a special gift to a particular person, such as a piece of jewelry to a particular child? 2. Briefly describe your desired plan of distribution for assets remaining after any specific gifts are distributed: (Do not worry about tax planning or other considerations in answering this question. We will consider those details later.) All to spouse; then equally between children, and if a child didn t survive, the deceased child s children would take the share of the deceased child. All to spouse, then equally among surviving children. All to spouse, then As follows:

Per capita: In the event that one or more of your named beneficiaries predeceases you, then his or her share would be given to the then remaining named beneficiaries in equal shares. Per stirpes: In the event that one or more of your beneficiaries predecease you, then his or her share would be given to his or her then surviving issue (ie children, grandchildren etc), in equal shares. By representation in each generation: This is used to ensure equal distribution among grandchildren, etc when you have two or more beneficiaries with unequal numbers of children. If two or more of your beneficiaries predecease you, then their shares will be combined and divided equally among all of their issue in each generation. For instance, you have three children, Joe, Bob and Stan. Joe and Bob have two children each, but Stan has three children. Bob predeceases you, leaving two children and Stan predeceases you, leaving three children. To ensure that each of these grandchildren inherit equal amounts, Bob s share and Stan s share would be combined, and then divided equally among their five children. Otherwise, Bob s children would inherit his share divided in two parts, while Stan s share would have to be divided in three parts. Other: 3. ULTIMATE DISTRIBUTION. You might want to provide for the distribution of your property (to a charity, church, school, etc) if neither of you, nor your children or other beneficiaries named above survive a common disaster. APPOINTMENTS 1. PERSONAL REPRESENTATIVE. The will should name a personal representative to probate the estate. (Personal representative is also sometimes referred to as executor or administrator.) Most people name their spouse as primary personal representative, with a child, relative, friend, or corporate trustee as alternate. PERSONAL REPRESENTATIVE: Relationship and Address (if not above-stated): ALTERNATE: Relationship and Address (if not above named):

SECOND ALTERNATE: Relationship and address (if not above named): 2. SUCCESSOR TRUSTEE. If you choose to avoid probate of your estate by executing a living trust during your lifetime, a successor trustee should be named. The successor trustee would be responsible for managing assets if neither you nor your spouse could manage assets due to incompetency, and the successor trustee would distribute assets to beneficiaries after neither you nor your spouse survive. The successor trustee is often the same individual or institution named as alternate personal representative. SUCCESSOR TRUSTEE: Relationship and address (if not above named) ALTERNATE: Relationship and address (if not above named) PLEASE COMPLETE THIS SECTION ONLY IF YOU HAVE MINOR OR DISABLED BENEFICIARIES (otherwise, move on to question 4): 3. GUARDIAN. If you have minor children or an incompetent child, you will need to appoint a guardian. The guardian is responsible for the day-to-day care of the child. It is a good idea to name an alternate guardian in the event your first choice cannot serve. GUARDIAN: Relationship and Address (if not above named) ALTERNATE: Relationship and address (if not above named) SECOND ALTERNATE: Relationship and address (if not above named) 4. TESTAMENTARY TRUSTEE. You may need a trustee to manage assets for children until they reach an age when you believe they should be capable of managing property on their own. A trustee can keep the children s money invested wisely and use it for their education, support, etc., until they reach the age specified for outright distribution of assets to them. The trustee can be a relative, friend, trust company or other person you

trust to manage and distribute assets according to your wishes. The testamentary trustee can be the same person named as the guardian, or could be a different person. TESTAMENTARY TRUSTEE: Relationship and Address (if not above named) ALTERNATE: Relationship and address (if not above named) AGE OF DISTRIBUTION. If you do establish a trust to allow a third party to manage assets for beneficiaries, then it is necessary for you to decide when the beneficiaries will be mature enough to manage assets on their own. You may want to give each beneficiary his/her share at the time the beneficiary reaches a particular age. You may consider splitting the distribution, such as ½ at age 25 and the balance at age 30, or 1/3 at 21, 1/3 at 25, and 1/3 at 35. You may use any age or combination of ages that you choose. POWER OF ATTORNEY/ LIVING WILL POWER OF ATTORNEY: If you plan to execute a Power of Attorney, in other words, designate an agent to handle your affairs (such as banking, real estate, contracts, investments, etc.) in the event of disability, please list the following: Agent: Substitute: Husband: Name Address Relationship Wife: Name Address Relationship Agent: Substitute:

LIVING WILL: If you wish to advise medical care providers when to disconnect life support and to designate a health care representative to enforce your wishes and make medical decisions when you are unable to do so, please list your designated health care representative in the order of your preference (i.e., first choice, second choice and third choice.) 1) 2) 3) Husband: Name Address Phone Number Wife: Name Address Phone Number 1) 2) 3) GENERAL QUESTIONS NOTES AND QUESTIONS: Please note anything else which may be of importance in planning your estate, or note any special questions you may have. CLIENT SIGNATURE: This shall acknowledge that I understand that The Law Office of Richard D. Meinders, P.C. will rely upon the completeness and accuracy of all information provided in this Worksheet, and that I have completed same to the best of my knowledge and belief. Client Signature and Date