Estate Planning Checklist Estate Planning Information Sheet Date completed MM slash DD slash YYYY All information will be kept CONFIDENTIAL, unless you authorize or request its release to others. The purpose of this questionnaire is to: 1) help you organize personal and financial information so that you can assess your current estate plans and evaluate whether changes are necessary; and (2) provide me with the information needed to make a similar analysis.Note: Not all of the questions will apply to your circumstances.Will & Trust Background InformationDo you have a will? yes no Do you have a trust? yes no PERSONAL INFORMATION State the names requested below exactly as you want them to appear in your estate planning documents.Your legal name:Your Date of birth MM slash DD slash YYYY Spouse's/partner's legal name:Spouse's Date of birth MM slash DD slash YYYY Date of marriage (if married) MM slash DD slash YYYY Are you subject to a Prenuptial Agreement? yes no Your Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Email Spouse's Email (if applicable) Telephone No. (s)(home)(your cell)(spouse's cell)Are you a United States citizen? yes no Is your spouse a United States citizen? yes no PRIOR MARRIAGES (if applicable)Name of Prior SpouseDate of Marriage MM slash DD slash YYYY Date of Divorce MM slash DD slash YYYY Name of Prior SpouseDate of Marriage MM slash DD slash YYYY Date of Divorce MM slash DD slash YYYY Name of Prior SpouseDate of Marriage MM slash DD slash YYYY Date of Divorce MM slash DD slash YYYY FAMILY INFORMATIONPlease name all of your children. If a child is from a former marriage, please indicate whose child it is by listing the name of that spouse, along with the information of WHOSE child in the chart below. Please name all children you have ever had, including deceased children (whether or not their descendants will be included in your plan). Please note if the child is adopted or a step-child. If you do not have any children, please list: (1) Names of Parents (living or deceased); and (2) Names of any siblings (living or deceased).ListFull NameRelationshipWhose? Or Both?Birth dateSingle? Married? Divorced?Town and State of Residence SingleMarriedDivorced Add RemoveDo any of the people identified above have any special mental, physical or educational needs? If so, please identify them and briefly describe any concerns.Do any of the people identified above have any special mental, physical and educational needs? If so, please identify them and briefly describe any concerns.If you have any specific wishes for your pets, please list them here:If you have any specific wishes for your pets, please list them herePERSONAL AND FAMILY FINANCIAL ASSETSPlease indicate:Your current place of employment:Spouse's current place of employment:Real Estate OwnershipAddressMortgage balanceCurrent market valueAddressMortgage balance2Current market value2AddressMortgage balance3Current market value3TOTALSTotal Mortgage balanceTotal Current market valueAsset SummaryCurrent assets and liabilities:TOTAL ASSETS (excluding insurance)YouSpouseJointLiabilitiesTOTAL LIABILITIESYouSpouseJointNet WorthSubtract total liabilities from total assetsNumberNumberNumberAmount of Life InsuranceYouSpouseOther interests of current or future value1. Interests in trusts:Describe any trusts created by you or inherited, in which you or a member of your immediate family has a right to receive distributions of income or principal . Also state the approximate current value of the trust and the annual income from it.PERSONAL ESTATE PLANNING OBJECTIVES1. Please list any specific bequests of personal property or money that you would like to leave and to whom.2. How would you like the remainder of your personal property distributed?3. How would you like the remainder of your other assets distributed?4. If you have children, upon your death do you want them to receive their share of your estate outright or in trust?5. If you leave assets directly to a child or children, how should their share be distributed if they fail to survive you? (to their children, back to other children/descendants or elsewhere)6. If you decide to leave your assets to your children in a trust, at what age or ages would you want them to receive the principal?7. In the event of an unforeseen situation that was to claim the lives of your entire immediate family where would you want your assets to go?8. Do you intend to disinherit anyone? If so, please provide their name(s) and your relation to them.9. Is there anyone likely to contest your estate documents? If so, whom?GUARDIANS, EXECUTORS AND TRUSTEES1. Guardians for minor children If you have minor children, who would you like to designate as a guardian or guardians of the person and their estate if you and your spouse were to die or become incapacitated. (a) GuardianNameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (b) Successor Guardian.NameAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 2. Executor Your executor has the responsibility to wind up your affairs at the time of your death. Who would you like to designate as your Executor(s) upon your death and the death of your spouse? (a) ExecutorName(s)Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (b) Successor Executor. (to act if one or more of the initial executor(s) cannot or does not act.)Name(s)Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 3. Trustees If you choose to form a trust, your trustees are responsible for the management of the trust, and distribution of the trust funds. Whom would you like to designate as Trustee(s)? Note: Generally the trustee of your trust and guardian of your children should not be the same person. (a) Initial trustees or Co-trustee(s)Name(s)Address(es)(b) Successor Trustees (to act if one or more of the initial trustee(s) cannot or does/do not act).Name(s)Address(es)OTHER MATTERS1. Powers of attorney Would you like us to prepare a general durable Power of Attorney? This document would allow someone to handle financial matters on your behalf.Would you like us to prepare a general durable Power of Attorney? This document would allow someone to handle financial matters on your behalf if you are unable to do so. Because this is durable, it remains in effect if you become incompetent(Required) Yes No If yes, please provide the name and address of the person to appoint, and a successor if desired. Name and address of the person to appoint2. Health Care Instructions Would you like us to prepare a document indicating your wishes concerning the extraordinary measures to be taken to save your life in the event of a catastrophic illness or injury? This would authorize another person to make decisions with respect to your health care in the event you are unable to do so, and designate a conservator in the event one is needed.Would you like us to prepare a document indicating your wishes Yes No If yes, please provide the name and address of the person to appoint, and a successor if desired. Name and addresses3. Cremation/Burial Service ArrangementDo you want to be cremated? Yes No What are your burial or cremation wishes, if any?OrDo you want to be buried? Yes No What are your burial or cremation wishes, if any?Name(s), addresses and phone numbers of the person(s) you would you like to select in order to make arrangements?NameAddressPhone Number Add Remove4. Other Estate Planning MattersAre there any other estate planning matters you would like us to address for you? yes no
