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: _______________________________