Estate Planning Checklist I. FAMILY MEMBERS Husband's Name (required) Husband's Age (required) Wife's Name (required) Wife's Age (required) Address (required) Phone (required) Email (required) Children Child #1 Name Address Age Marital Status Number of Children They Have Child #2 Name Address Age Marital Status Number of Children They Have Child #3 Name Address Age Marital Status Number of Children They Have Child #4 Name Address Age Marital Status Number of Children They Have Child #5 Name Address Age Marital Status Number of Children They Have Family Remarks: Please note whether you or any of your children had a previous marriage or have special problems as to health or otherwise. If a spouse is deceased, state date of death. If either spouse is not a U.S. Citizen please so indicate: State whether any minor child of yours has separate assets, and if so, where are they held: II. REAL ESTATE * Indicate if rental property. ** I.E.: joint, tenants by the entirety, individual trust. Primary Residence Location* Approximate Value $ Mortgage Balance $ Form of Ownership** Secondary Residence Location* Approximate Value $ Mortgage Balance $ Form of Ownership** Investment Property Location* Approximate Value $ Mortgage Balance $ Form of Ownership** List any additional real estate you own, and please have copies of all deeds ready. If property is held in trust, please have a copy of the trust ready. III. INCOME AND ASSETS A. Income Husband's Income $ (required) Wife's Income $ (required) Any anticipated extraordinary increases or decreases in income? Husband's Occupation (required) Wife's Occupation (required) B. Assets For estate tax purposes, it is important to have some idea of the value of your total assets, including all real estate, cash, securities, proceeds from insurance that would be paid to a beneficiary on your death, and your personal property of significant value. Do you estimate your total assets at over $850,000? (required) —Please choose an option—YesNo If so, at over $1.5 million? (required) —Please choose an option—YesNo You can compile more detailed information at section IX of this checklist if you wish; filling in the additional information may help you determine the total value of your assets. IV. DISPOSITION OF ASSETS Please indicate, in a general way, your wishes regarding the disposition of your property, i.e., the desired shares of your children, charity, etc. (required) And have your present Wills or Trusts, if any, and any gift tax returns you have previously filed ready. V. EXECUTORS, TRUSTEES, AGENTS, GUARDIANS You will need to name an individual or individuals to serve as your Executor, to have Power of Attorney over your business and legal affairs, and to act as Health Care Agent. In addition, if you have minor children, you will need to name a Guardian or Guardians for them, and a Trustee or Trustees to administer any trust you set up for their benefit. In addition to names, please supply addresses of proposed Executors, Trustees, Health Care Agents, and Guardians, and their relationship to you: Executor Executor Alternate Guardian Guardian Alternate Trustee Trustee Alternate Power of Attorney Power of Attorney Alternate Health Care Agent Health Care Agent Alternate Note: In the event you choose a bank to serve as your Executor or Trustee, a copy of this form will be sent to that bank, if requested, unless you indicate otherwise. VI. SAFE DEPOSIT Safe Deposit Box location, persons who have access, and contents: VII. ADDITIONAL COMMENTS Include below any additional comments, special concerns, information,or specific questions you wish to have answered: ASSETS CHECKLIST NOTE: FILLING IN THE REMAINING INFORMATION ON THIS CHECKLIST IS HELPFUL BUT NOT REQUIRED TO BEGIN THE PROCESS OF DRAFTING YOUR ESTATE DOCUMENTS. You can fill in some or all of this information at this time if you wish. VIII. ADDITIONAL ASSET AND LIABILITY INFORMATION A. Public Stocks, Bonds, Mutual Funds, etc., (approximate total value) Husband $ Wife $ Joint $ Remarks: (If you have a statement or other schedule of your holdings, please attach that. Also, please note any special situations, such as very cost-basis stock or stock options.) B. Cash and Bank Accounts Details Needed: Bank & Type (Money Mkt., Savings, etc.) / Approx. Balance / In whose name or names? Bank Account #1 Bank Account #2 Bank Account #3 Bank Account #4 C. Life Insurance Details Needed: Person Insured / Face Amount / Beneficiary / Owner / Type of Policy / Name of Company Life Insurance #1 Life Insurance #2 Life Insurance #3 Life Insurance #4 D. Family Business Interests Name of Business and Location Your Share of Business Your Position Desired Disposition of Business Your Estimate of Value $ Is there a Buy/Sell Agreement? —Please choose an option—YesNo (Have a copy of the most recent financial statement and tax return from the business, and a copy of the Buy/Sell Agreement, if any.) E. Pension, Profit Sharing, IRA, Keogh or other Retirement Plans Indicate Company, type of plan, lump sum value or monthly payments, and beneficiary: Husband Wife F. Tax Shelter Information (including limited partnerships) Indicate briefly any tax shelters you have (i.e., type of real estate, oil/gas, etc.) and amount invested: G. Miscellaneous (i.e., expectancies, powers of appointment; valuable personal property; promissory notes; annuities; significant past gifts made by you; any other special factors which may affect your situation-use) H. Liabilities Indicate any significant debts including debts of others guaranteed by you, as well as lawsuits, present or anticipated: IX. OTHER PROFESSIONAL ADVISORS CPA's Name CPA's Phone Insurance Advisor's Name Insurance Advisor's Phone Stockbroker's Name Stockbroker's Phone Other's Name Other's Phone X. If first time client, please indicate how you were referred: ADDITIONAL COMMENTS:
