Estate Planning and Will Information Form Hidden H2 Δ Step 1 of 5 20% WHEN YOU HAVE COMPLETED THIS FORM, please return it to our office or bring it along to your office conference. We rely upon the information you provide us to be accurate and complete in all respects. If the information is not accurate and complete, the recommendations we make may not be appropriate for your situation. 1. Testator (Person(s) making Will)Name:(Required)Date of Birth Social Security NoU.S. Citizen? Yes No Spouse’s Name(Required)Date of Birth Spouse’s Social Security NoU.S. Citizen? Yes No Street AddressAptCountyCityStateZipState of ResidenceTelephone NumberCell/ClientCell/Spouse2. MarriageHave you and your spouse signed a Premarital Agreement? If you have, please provide a copy. Yes No File Drop files here or Select files Max. file size: 256 MB. Have you or your spouse been divorced? If so, please provide a copy of the Divorce Decree. Yes No File Drop files here or Select files Max. file size: 256 MB. 3. ChildrenPlease list ALL your children, including deceased children, children born out of wedlock, and children you wish to omit from your estate plan.ListName of ChildDate of BirthAddressChild of Add Remove Identify any child who is not a biological or adopted child of both you and your spouse if any. Yes No Identify HereHave any children received an advance on their inheritance or are any children financially indebted to you? If so, please explain. Yes No Please ExplainIs there any reason NOT to treat your children equally? If so, please explain. Yes No Please ExplainAre any of the children under a disability? Yes No Do you have any special concerns or objectives regarding your children? Yes No ConcernsGuardians. Who should be guardian of your minor children? (A guardian has physical and legal control over your children until they reach the age of 18.)Name(Required)AddressAlternate GuardianAddress4. Personal RepresentativeWho should be personal representative (“executor”) of your estate? A personal representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate. NameRelationship to youAddressPhone NumberAlternate Personal RepresentativeRelationship to youAddressPhone Number5. TrusteeWho should be the trustee for any trust established under your will?NameRelationship to youAddress 6. Financial InventoryUse approximate values under each person showing ownership of each asset. BRING SUPPORTING DATA FOR EACH ASSET, i.e., bank statements, retirement reports, stock and bond account reports, etc. NOTE: If you are entering into a revocable (living) trust, bring copies of deeds to real estate you own. AssetsHomeHomeHUSBANDWIFEJOINTMORTGAGE OR LIENOther Real Estate Other Real EstateHUSBANDWIFEJOINTMORTGAGE OR LIENChecking AccountChecking AccountHUSBANDWIFEJOINTMORTGAGE OR LIENSavings AccountSavings AccountHUSBANDWIFEJOINTMORTGAGE OR LIENMoney Market Account Money Market AccountHUSBANDWIFEJOINTMORTGAGE OR LIENAutomobileAutomobileHUSBANDWIFEJOINTMORTGAGE OR LIENPersonal PropertyPersonal PropertyHUSBANDWIFEJOINTMORTGAGE OR LIENStocks & BondsStocks & BondsHUSBANDWIFEJOINTMORTGAGE OR LIENClosely Held Business Interest Closely Held Business InterestHUSBANDWIFEJOINTMORTGAGE OR LIENRetirement Accounts: Retirement AccountsHUSBANDWIFEJOINTMORTGAGE OR LIENIRA IRAHUSBANDWIFEJOINTMORTGAGE OR LIENPension PensionHUSBANDWIFEJOINTMORTGAGE OR LIENProfit Sharing/401kProfit Sharing/401kHUSBANDWIFEJOINTMORTGAGE OR LIENOther AssetsOther AssetsHUSBANDWIFEJOINTMORTGAGE OR LIENTOTAL TOTALHUSBANDWIFEJOINTMORTGAGE OR LIEN 7. Beneficiary DesignationsLife Insurance & Retirement Plans:Life Insurance & Retirement Plans:Life Insurance CompanyFace ValueOwnerInsuredBeneficiary Add Remove8. Financial AdvisorsAccountantAddressTelephoneFinancial AdvisorAddressTelephone9. Special RequestsSpecial requests regarding funeral, cremation, or burial instructions are best handled by a Letter of Instruction or other statement (separate from your will) to your family or other responsible person. Organ donation is best handled in a Health Care Directive and noted on the person’s drivers license. Yes No File Drop files here or Select files Max. file size: 256 MB. 10. Discussion IssuesWe will discuss the following issues at the meeting.Current Will. Do you now have a will or revocable trust? If so, provide a copy. Yes No File Drop files here or Select files Max. file size: 256 MB. Predeceased Child. If any child should predecease parent, should his/her share pass through to his/her children? If so, please indicate grandchildren, if any. Yes No Predeceased ChildWhat age should grandchildren be able to access the principal of an inheritance?Do you wish to include grandchildren born out of wedlock? Yes No Loan Guarantees. Have you guaranteed any loans for your children, grandchildren or any other person? If so, bring details to meeting. Yes No Details to MeetingTrusts. Do you wish to have a trust established for the benefit of your spouse and/or children? Yes No Specific Gifts. Do you wish to make any specific bequests to charities or individuals? Yes No No Family Survives. How should your estate be distributed if your spouse and/or children do not survive you? Family Charity If no Children. If you do not have children, to whom should your estate pass (beyond a spouse, if any)?Health Care Directive. Are you interested in preparing a Health Care Directive appointing someone to make health care decisions for you and/or stating your preferences for health care? This document can also include instructions regarding organ donation. Yes No File Drop files here or Select files Max. file size: 256 MB. Power of Attorney. Are you interested in preparing a Power of Attorney granting another person the power to act on your behalf to manage your assets and pay your bills if you become incompetent or unable to sign your name? Yes No Health Care DirectiveAgent. Name, address and telephone number of the person who you want to make health care decisions if you cannot make them yourself: Yes No NameAddressTelephone NumberSuccessor or Co-Agent’s name, address, and telephone number: Yes No NameAddressTelephone NumberIf you have named co-agents, do you want the agents to act jointly or independently? Jointly Independently Do you want directions as to what you want or do not want if you are in a terminal condition (i.e., not expected to live more than 6 months)? Yes No Do you want to donate any organs upon your death? Yes No If yes, have you agreed in another document, e.g., drivers license, to make the donation? Yes No Please indicate how you want the disposition of your remains after you die, e.g., cremation, regular burial, etc.: Cremation Regular Burial Other OtherDo you have other health care powers of attorney forms which you want to revoke? We recommend revocation to keep your wishes and desires clear. Yes No Do you have any other instructions regarding your health care, living arrangements, burial, etc.? If so, please indicate: Yes No Please indicateDurable Power of AttorneyAgent. Name, address and telephone number of the person who you want to make health care decisions if you cannot make them yourself: Yes No NameAddressTelephone NumberSuccessor or Co-Agent’s name, address, and telephone number: Yes No NameAddressTelephone NumberIf you have named co-agents, do you want the agents to act jointly or independently? Jointly Independently Have you signed any other Durable Power of Attorney forms? We recommend revocation to keep your wishes and desires clear. Yes No Wishes & DesiresYou can download a copy of this form by Clicking Here.
