Fill and Sign the Phone Thats Not Smart or Mobiledailyanswersnet Form

Your Personal Information NAME ____________________________________ BIRTHDATE _____________SPOUSE __________________________________ BIRTHDATE _____________HOME ADDRESS ____________________________________________________CITY ___________________________ STATE ___________ ZIP __________HOME TELEPHONE ( ) WORK PLACE-HIS __________________________________________________ADDRESS__________________________________________________________WORK TELEPHONE ( ) WORK PLACE-HER __________________________________________________ADDRESS __________________________________________________________WORK TELEPHONE ( ) SOCIAL SECURITY #: YOU __________________ SPOUSE ________________ MARITAL STATUS: [] MARRIED [] SINGLE [] WIDOW(ER) [] DIVORCED [] LEGALLY SEPARATED UNITED STATES CITIZEN: YOU: [] YES [] NO; SPOUSE [] YES [] NO I. CHILDREN: (indicate if adopted)1. NAME ________________________________ BIRTHDATE ______________CHILD'S SPOUSE _________________________ MINOR CHILDREN? []YES []NOCITY AND STATE _________________________2. NAME ________________________________ BIRTHDATE_______________CHILD'S SPOUSE _________________________ MINOR CHILDREN? []YES []NO CITY AND STATE _________________________3. NAME ________________________________ BIRTHDATE______________CHILD'S SPOUSE _________________________ MINOR CHILDREN? []YES []NOCITY AND STATE _________________________4. NAME ________________________________ BIRTHDATE______________CHILD'S SPOUSE _________________________ MINOR CHILDREN? []YES []NOCITY AND STATE _________________________5. NAME ________________________________ BIRTHDATE______________CHILD'S SPOUSE _________________________ MINOR CHILDREN? []YES []NOCITY AND STATE _________________________II. BACKGROUND INFORMATION: A. PREVIOUS MARRIAGES: FORMER SPOUSE: __________________________________ DATE & PLACE OF MARRIAGE: __________________________________ HOW TERMINATED: __________________________________DATE: __________________________________ B. DIVORCE OBLIGATIONS (PAY/RECEIVE): CHILD SUPPORT: __________________________________ALIMONY: __________________________________LIFE INSURANCE: __________________________________OTHER TERMS: __________________________________ C. ARE THESE CHILDREN FROM THIS MARRIAGE? [] YES [] NO IF NO, PLEASE EXPLAIN: _____________________________________ D. ARE THERE SPECIAL NEEDS FOR ANY CHILD? [] YES [] NO IF YES, PLEASE EXPLAIN: ____________________________________ E. DO YOU SUPPORT OR EXPECT TO SUPPORT ANYONE ELSE SUCH AS A PARENT OR OTHER PERSON? [] YES [] NOIF YES, PLEASE EXPLAIN: ____________________________________ F. MILITARY SERVICE: (BRANCH, RANK, SERIAL #, DATES): _________ ____________________________________________________________ G. DESCRIBE ANY SIGNIFICANT HEALTH PROBLEMS: __________________ ____________________________________________________________ H. NAME & ADDRESS OF PHYSICIAN: _______________________________ III.KEY PEOPLE IN YOUR ESTATE PLAN: A. EXECUTORS OF WILLS: FIRST Spouse [ ] Other ADDRESS__________________________________________________________ALTERNATE________________________________________________________ADDRESS__________________________________________________________SECOND ALTERNATE ________________________________________________ADDRESS__________________________________________________________ B. TRUSTEES OF TESTAMENTARY OR REVOCABLE LIVING TRUSTS: ORIGINAL Spouse(s) [ ] Other 1ST SUCCESSOR ___________________________________________________2ND SUCCESSOR ___________________________________________________3RD SUCCESSOR ___________________________________________________ C. GUARDIANS FOR MINOR CHILDREN: FIRST ___________________________________________________________SECOND __________________________________________________________THIRD ___________________________________________________________ ESTATE PLANNING DATA SHEET INFORMATION FOR YOUR EXECUTOR(S) PART II I.INVENTORY OF ASSETS (Please complete with full information):A. REAL ESTATE (Including condominium apartment) DATE COST PLUS CURRENT MORTGAGE NET CURRENT DESCRIPTION PURCHASED IMPROVEMENTS VALUE PAYABLE VALUE B. BUSINESSES IN WHICH YOU HAVE AN INTEREST: (Put additional businesses on back of page)*TYPE: C-CORPORATION S-S CORPORATION SP-SOLE PROPRIETORSHIP P-PARTNERSHIP PC-PROFESSIONAL CORPORATION 1. NAME OF BUSINESS: ______________________________________________ WHAT DOES BUSINESS DO?__________________________________________ *TYPE SHAREHOLDERS/PARTNERS OWNERSHIP VALUE ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________WHO WILL CONTINUE THE BUSINESS UPON RETIREMENT OR DEATH? _____________________________________________________________________ DO YOU HAVE BUY-SELL AGREEMENTS FOR THE BUSINESS? _____________________________________________________________________ DO YOU HAVE KEY-MAN AND/OR DISABILITY INSURANCE? _____________________________________________________________________C. STOCKS AND BONDS 1. Listed Securities (stocks and bonds) NO. OF SHARES DATE ORIGINAL CURRENT DESCRIPTION OR FACE VALUE ACQUIRED COST MARKET VALUE 2.U.S. Government Bonds (e.g., Series "E" or "EE" bonds) PAYABLE ON FACE VALUE DEATH TO ISSUE DATE CURRENT VALUE D. 1. CASHNAME & ADDRESS ACCOUNT CHECKING ORTRUST ACCOUNT CURRENT OF BANK NUMBER SAVINGS BENEFICIARY BALANCE 2. MORTGAGES and PROMISSORY NOTES NAME OFMORTGAGEE UNPAID REPAYMENT INTERESTOR CREDITOR FACE VALUE BALANCE TERMS RATE E.LIFE INSURANCECOMPANY:_________________________POLICY NAME OF NAME OFTRANSFERRED, CURRENT FACE DEATHNUMBER INSURED OWNER DATE BENEFICIARY VALUE LOAN VALUE F.ANNUITIES AND DEATH BENEFITS (Include Keogh plans and IRAs) ANNUITY OR DESIGNATED ESTATE OWNER'S APPROX. TYPE OF PLAN LUMP SUM PAYOUT BENEFICIARY CONTRIBUTION VALUE