Estate Planning Client Information Questionnaire:
Date: ____________
Urgency of Planning: ___________________________________
Who is Plan For: ______________________________
Personal Information:
Full Legal Name: _______________________________
Other Names Used (maiden, prior marriages, nicknames): _______________________________
Date of Birth: _______________________________
Social Security Number: _______________________________
Current Address: _______________________________
Phone & Email: _______________________________
Marital Status: _______________________________
Citizenship/Residency Status: ______________________________
Current Estate Planning Documents
_____ Existing Will Date Executed: ___________________
_____ Existing Trust(s) Date Executed: ___________________
_____ Powers of Attorney (financial & medical) Date Executed: ___________________
_____ Living Will / Advance Directive Date Executed: ________________________
_____ HIPAA Authorization Date Executed: __________________
Estate Planning Goals:
_____ Name Beneficiaries who will Receive Property
_____ To Specific How and When to Distribute Property
_____ Appoint Fiduciaries – Personal Representative, Trustee, Power of Attorney, Guardian
_____ Appoint Healthcare Power of Attorney
_____ Appoint Financial Power of Attorney
_____ Plan for Long Term Care
_____ Specify Advanced Medical Directives
_____ Appoint Guardian if incapacitated
_____ Avoid Probate
_____ Protect Assets
_____ Name Guardians for Minor Children
_____ Name Guardian for Pet Care
_____ Specify Preferences for funeral/burial/cremation
Assets:
Real Estate:
Address: ___________________________________________________________________________________
Residence or Investment: _________________
Mortgage: _____________________________________________________________
Jointly or Solely Owned: _____________________________________________
Bank Accounts: _______________________________
Investment Accounts: _______________________________
Retirement Accounts: _______________________________
Life Insurance: _______________________________
Personal Property (vehicles, jewelry, collectibles): _______________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Business Interests: _______________________________
Other Assets: _________________________________________________________________________________________
Debts:
Mortgages: _______________________________
Loans (auto, student, business): _______________________________
Credit card debt: _______________________________
Lines of credit: _______________________________
Other obligations: ________________________________________________________________________
People – Spouse/Partner Information
Full Legal Name: _______________________________
Date of Birth: _______________________________
Social Security Number: _______________________________
Citizenship/Residency Status: _______________________________
Single, Married, Separated, Divorced, Widowed: ________________________
Date & Place of Marriage: _______________________________
Prior Marriages (details): _______________________________
People – Children, Grandchildren and Other Dependents
Name: ____________________________________________
Date of birth: ______________________________________
Address: __________________________________________________________________________
Biological / Adopted / Step-Child / Other: _______________________________
Special Needs or Disabilities: _______________________________
Financial Dependence Status: _______________________________
Custody/Guardianship Considerations: _______________________________
Name: ____________________________________________
Date of birth: ______________________________________
Address: __________________________________________________________________________
Biological / Adopted / Step-Child / Other: _______________________________
Special Needs or Disabilities: _______________________________
Financial Dependence Status: _______________________________
Custody/Guardianship Considerations: _______________________________
Name: ____________________________________________
Date of birth: ______________________________________
Address: __________________________________________________________________________
Biological / Adopted / Step-Child / Other: _______________________________
Special Needs or Disabilities: _______________________________
Financial Dependence Status: _______________________________
Custody/Guardianship Considerations: _______________________________
Name: ____________________________________________
Date of birth: ______________________________________
Address: __________________________________________________________________________
Biological / Adopted / Step-Child / Other: _______________________________
Special Needs or Disabilities: _______________________________
Financial Dependence Status: _______________________________
Custody/Guardianship Considerations: _______________________________
People – Family Background
Parents (living/deceased, names, addresses): _______________________________
Siblings (names, addresses, living/deceased): _______________________________
Other close family members: _______________________________
Special Considerations
Blended family issues: _______________________________
Special needs planning: _______________________________
Non-citizen spouse planning: _______________________________
Out-of-state or international property: _______________________________
Digital assets: _______________________________
Firearms / NFA items: _______________________________
Health and Long-Term Care
Current health conditions: _______________________________
Long-term care insurance: _______________________________
Health Insurance: _________________________________
Preferences for nursing home, assisted living, or in-home care: _______________________________
Beneficiaries
Beneficiaries to be named in Will or Trust: ___________________________________________________
_____________________________________________ ____________________________________________________
_____________________________________________ ____________________________________________________
_____________________________________________ ____________________________________________________
Beneficiaries to be Designated on Investment, Life Insurance, Retirement, Bank Accts:
_____________________________________________ ____________________________________________________
_____________________________________________ ____________________________________________________
_____________________________________________ ____________________________________________________
Fiduciary Appointments
Personal Representative (Will): _______________________________
Trustee(s) (Trusts): _______________________________
Guardian(s) for children: _______________________________
Guardian(s) for self if incapacitated: _______________________________
Agent(s) under Financial Power of Attorney: _______________________________
Agent(s) under Health Care Power of Attorney: _______________________________
Alternate or Successor Fiduciaries: _______________________________