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.

Name*
Also known as
Date of birth
Soc. Sec. #
Email*
US Citizen
- Yes
- No
Living parents
Former spouse(s)
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone
Home Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Are you married?
- Yes
- No
Spouse Name*
Also known as
Date of birth
Soc. Sec. #
Email
US Citizen
- Yes
- No
Living parents
Former spouse(s)
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone
Home Address
Street Address Address Line 2 City State ZIP Code
Home Phone

Children
Living 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 husband and wife.
- 1
- 2
- 3
- 4
- 5
- 6
Child's Name
Age
Address
Child's Name
Age
Address
Child's Name
Age
Address
Child's Name
Age
Address
Child's Name
Age
Address
Child's Name
Age
Address
Deceased children
Living children of deceased children

1. Real Estate (including land contracts)
Description
Owner (husband, wife, joint)
Mortgage Balance
Market Value
Description
Owner (husband, wife, joint)
Mortgage Balance
Market Value
Description
Owner (husband, wife, joint)
Mortgage Balance
Market Value
Description
Owner (husband, wife, joint)
Mortgage Balance
Market Value

2. Cash (checking, savings, CD, money market, credit union)
Location of Account
Owner (husband, wife, joint)
Amount
Location of Account
Owner (husband, wife, joint)
Amount
Location of Account
Owner (husband, wife, joint)
Amount
Location of Account
Owner (husband, wife, joint)
Amount

3. Stocks and Bonds
Listed securities (husband)
Listed securities (wife)
Listed securities (joint)
Closely held (family) securities
4. Life Insurance
Insured
Company
Type of Insurance
Owner Beneficiary
Face Amount
Insured
Company
Type of Insurance
Owner Beneficiary
Face Amount
5. Retirement
Retirement benefits (list company)
IRA (list location and amount)

6. Miscellaneous
Household furnishings, auto, collections
Value
Money owed by others to you
Value
List all gifts made by you over $12,000 in value (date and beneficiary)
Miscellaneous (trusts, etc.)
Value
Any gift tax returns filed?
- Yes
- No
Years filed
List significant debt or obligations other than mortgages listed above

7. Appointments Under Your Will
Primary Beneficiary - Husband
Primary Beneficiary - Wife
Secondary Beneficiary - Husband
(If not survived by primary beneficiary)
Secondary Beneficiary - Wife
(If not survived by primary beneficiary)
Personal Representative for Husband's Will
Personal Representative for Wife's Will
Alternate Personal Representative for Husband's Will
(Adult child or other adult person)
Alternate Personal Representative for Wife's Will
(Adult child or other adult person)
Trustee for Husband's Joint Trust
(Trustee or Spouse) who will serve under your Revocable Living Trust or in a testamentary trust in your Will?
Trustee for Wife's Joint Trust
(Trustee or Spouse) who will serve under your Revocable Living Trust or in a testamentary trust in your Will?
Alternate Trustee
(Adult child or another adult)
Alternate Trustee
(Adult child or another adult)
Guardian for minor children after both parents are deceased
(Adult relative or friend)
Guardian for minor children after both parents are deceased
(Adult relative or friend)
Alternate guardian(s) for minor children
Alternate guardian(s) for minor children
Person to hold financial Power of Attorney for Husband
Person to hold financial Power of Attorney for Wife
Alternate financial Power of Attorney for Husband
(Adult child or friend)
Alternate financial Power of Attorney for Wife
(Adult child or friend)
Person to hold medical Power of Attorney for Husband
Person to hold medical Power of Attorney for Wife
Alternate medical Power of Attorney
(Adult child or friend)
Alternate medical Power of Attorney
(Adult child or friend)
Husband's Alternative Patient Advocate's email address
Wife's Alternative Patient Advocate's email address
Comments
This field is for validation purposes and should be left unchanged.

Estate Planning Questionnaire

Estate Planning Questionnaire

Step 1 of 8

Children

Financial Contacts

1. Real Estate (including land contracts)

2. Cash (checking, savings, CD, money market, credit union)

3. Stocks and Bonds

4. Life Insurance

5. Retirement

6. Miscellaneous

7. Appointments Under Your Will