Estate Planning Questionnaire Estate Planning Questionnaire The information you provide in this questionnaire will be used to help organize your personal and financial information so we can properly assess your current situation and evaluate what documents are appropriate for you. Please complete this form to the best of your ability. Step 1 of 812%Name*Also known asEmail* Date of birth Date Format: MM slash DD slash YYYY Soc. Sec. # (Last 4 digits)US CitizenYesNoLiving parentsFormer spouse(s)Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneAre you married?YesNoSpouse Name*Also known asDate of birth Date Format: MM slash DD slash YYYY Soc. Sec. #Email US CitizenYesNoLiving parentsFormer spouse(s)Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneChildrenLiving children (includes and children from a prior marriage and any adopted children.)Note: If there are no living children, list the brothers and sisters (living and deceased) of you and spouse.123456Child's NameAgeAddressChild's NameAgeAddressChild's NameAgeAddressChild's NameAgeAddressChild's NameAgeAddressChild's NameAgeAddressDeceased childrenLiving children of deceased childrenFinancial ContactsSafe-deposit boxYesNoSafe-deposit box locationAccountantYesNoAccountant's nameInsurance agentYesNoInsurance agent's nameStock brokerYesNoStock broker's nameHave you ever resided in one of the following community law states while you where married: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin?YesNoName of state(s) and number of years resided there1. Real Estate (including land contracts)DescriptionOwner (you, spouse, joint)Mortgage BalanceMarket ValueDescriptionOwner (you, spouse, joint)Mortgage BalanceMarket ValueDescriptionOwner (you, spouse, joint)Mortgage BalanceMarket ValueDescriptionOwner (you, spouse, joint)Mortgage BalanceMarket Value2. Cash (checking, savings, CD, money market, credit union)Location of AccountOwner (you, spouse, joint)AmountLocation of AccountOwner (you, spouse, joint)AmountLocation of AccountOwner (you, spouse, joint)AmountLocation of AccountOwner (you, spouse, joint)Amount3. Stocks and BondsListed securitiesListed securities (spouse)Listed securities (joint)Closely held (family) securities4. Life InsuranceInsuredCompanyType of InsuranceOwner BeneficiaryFace AmountInsuredCompanyType of InsuranceOwner BeneficiaryFace Amount5. RetirementRetirement benefits (list company)IRA (list location and amount)6. MiscellaneousHousehold furnishings, auto, collectionsValueMoney owed by others to youValueMiscellaneous (trusts, etc.)ValueAny gift tax returns filed?YesNoYears filedList significant debt or obligations other than mortgages listed above7. Appointments Under Your Will/TrustPrimary Beneficiary(e.g. Spouse)Secondary Beneficiary(e.g. Children in equal shares or another person)Personal Representative(e.g. Spouse)Alternate Personal Representative(e.g. Adult child or friend)Guardian for minor children after both parents deceased(e.g. Adult child or friend)Trustee is grantor of Trust(One or two trustees, or the survivor)Successor Trustee (Can be adult child or another relative or friend)Financial Power of Attorney(Spouse, adult child/relative or friend to hold POA)Successor holder of POA(Adult relative or friend)Medical Power of Attorney, Patient Advocate(Spouse, adult child/relative or friend)Successor Medical POA, Patient Advocate(Spouse, adult child/relative or friend)NameThis field is for validation purposes and should be left unchanged.