Estate Planning Questionnaire

Name:

Birth date:   U.S. Citizen:

Principal Residence:

Any other Domicile:

Domicile in community property states (if ever):

Birthplace:   Social Security Number:

Dates of such domicile:

Community property acquired:

Business or profession:

Still: Active    Retired

Current marital status: Single Married Widowed Divorced

Prior Marriages (if any):

Name of former spouse(s):

Name and ages of children of prior marriages:

How and when prior marriage(s) ended:

Principal bank(s):

Personal Trust officer:

Location of safe deposit box(es):

Accountant:

Investment advisor:

Insurance advisor:

Name:

Date and place of birth:   U.S. Citizen:

Social Security Number:

Date and place of marriage:

Legally separated:

When and where:

Residence (if different from estate owner’s):

Business or profession:

(Designate which children or grandchildren, if any, are adopted, are stepchildren or are children of a prior marriage)

Name / Address / Age / Status

Executor(s)

Name:

Address:

Successor(s) Name:

Successor(s) Address:

Trustee(s)

Name:

Address:

Successor(s) Name:

Successor(s) Address:

Children’s Guardian(s)

Name:

Address:

Successor(s) Name:

Successor(s) Address:

(obtain copies of instruments of transfer and gift tax returns)

Donee:

Date of Gift:

Type of property given:

Date of gift value:

Outright or trust gift:

Was gift split with spouse? If yes, who paid gift tax?

A. REAL ESTATE (including condominium, apartment)

B. STOCKS AND BONDS

C. U.S. government bonds

D. CASH

E. MORTGAGES AND PROMISSORY NOTES

F. LIFE INSURANCE

G. GENERAL POWERS OF APPOINTMENT

H. ANNUITIES AND DEATH BENEFITS

(To avoid confusion at a later date, describe each item as clearly as possible.)

Total Debts and Liabilities:

Summary of Assets and Liabilities

Total Assets:

Less Total Liabilities:

Net Worth:

Income of Husband (Monthly)

Income of Wife

(Who will receive your property)

Do you want all property to go to spouse, or if spouse not alive to your children? Yes   If no please continue. If yes, stop.

Who is to receive home?

Describe who you desire to receive other property.

Describe any other last wishes

(For Additional Information)