CONFIDENTIAL ESTATE PLANNING QUESTIONNAIRE

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Your Social Security number and other personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.

Social Security numbers are most often used to positively identify parties. Most courts require Social Security numbers of all parties in a case. Some other examples of how this information may be used include:

initial service
in court orders
in required reports or other documents filed with the State

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

STEP 1: BACKGROUND INFORMATION

The information you provide in this section provides us with information about you, your age, marital status, where you live, and how best to contact you.

Client 1

Contact information: Contact 1

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Also Known As:

(other names such as maiden names, used to title property and accounts)

Prefer to be called:

Date of Birth - MM/DD/YYYY

Social Security Number

Citizenship:

Other

Employer:

Position:

It is okay to communicate with me via my E-mail address.

Yes

Did you have a documented marriage (by clergy, court or filing a license with a State):

Yes

Are either of your parents still living?

Yes

Are any of your grandparents still living?

Yes

Client 2

Contact information: Contact 2 (Spouse)

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Also Known As:

(other names used to title property and accounts)

Prefer to be called:

Date of Birth - MM/DD/YYYY

Social Security Number:

Citizenship:

Other

Employer Name

Position:

It is okay to communicate with me via my E-mail address.

Yes

Are either of your parents still living?

Yes

Are any of your grandparents still living?

Yes

CHILDREN AND/OR OTHER FAMILY MEMBERS OR BENEFICIARIES

For each beneficiary, please select "Yes" and fill out the following information.

Child or Other Beneficiary #1:

Yes

Child or Other Beneficiary #2:

Yes

Child or Other Beneficiary #3:

Yes

Child or Other Beneficiary #4:

Yes

Child or Other Beneficiary #5:

Yes

Child or Other Beneficiary #6:

Yes

Child or Other Beneficiary #7:

Yes

STEP 2: PLANNING OBJECTIVES/FAMILY VALUES

One of our goals is to assist you in identifying your estate planning objectives and family values so that we can focus our conversations on the issues most important to you.

Please rate the following planning objectives and family values on a scale of 1 to 5 as to how important they are to you. (5 critical, 4 very important, 3 important, 2 slightly important, 1 unimportant, N/A if inapplicable) Feel free to leave blank any item you do not wish to rank.

Protect Your Children or Other Beneficiaries

From predators who can discover inheritance amounts and target young or vulnerable beneficiaries:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From claims of divorced spouses to take half of your child or beneficiary’s inheritance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From malpractice claims, for beneficiaries with a professional practice:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From other creditors’ claims (such as car accident plaintiffs):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From the stress and delays of the average 6-16 month process of probate:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From the financial immaturity resulting in a quick loss of an inheritance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From sharing assets with heirs you would rather disinherit:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From litigation claims by disinherited heirs:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: from relatives who would be poor, abusive or even dangerous guardians or from foster care:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: from acquaintances and relatives who should not be allowed to be alone with your children:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For special needs beneficiary only: from neglect in the government care system:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Preserve and Maximize Assets

By minimizing taxes during your life (income taxes, capital gains taxes, estate taxes on inheritances you expect to receive):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By minimizing or eliminating estate taxes upon your death (up to 55% of your assets and life insurance benefits):

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By reducing estate administration costs through probate avoidance:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Ensure that a special needs beneficiary has assets that are protected from government seizure while retaining eligibility for needed services:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Ensure that your family has enough life insurance to provide a comfortable lifestyle:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

By ensuring that your assets are passed to your descendants and not given away to outsiders, such as spouses, creditors or the government:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Protect Yourself and Your Spouse

From malpractice or other creditor claims:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From conservatorship proceedings (aka “living probate”) if you become incapacitated:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From probate delays and stress upon your death or the death of your partner:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From hospital policies requiring life sustaining procedures when you would rather not endure them:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

From healthcare decisions made by people other than those you trust most:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Get your financial life organized:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Benefit a charitable organization or activity:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For parents only: By specifying the values, insights, stories, and experiences you want passed on to your children and how you want the money you leave behind used for your children:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For special needs beneficiary only: By providing instructions, people, and assets to support your special needs beneficiaries above a poverty lifestyle:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

For business owners only: By providing for the orderly continuation and transfer of family business interests rather than a distress sale:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Family Values

Cultural values such as art, music, travel:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Economic values such as financial responsibility, frugality, savings:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Educational values such as study, self-improvement, academic achievements, lifelong learning:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Spiritual values such as faith, belief in God, inner peace:

5 - Critical

4 - Very Important

3 - Important

2 - Slightly Important

1 - Unimportant

N/A - If Inapplicable

Other Concerns (Please list below):

STEP 3: ASSET INFORMATION

Determine the ownership, value, and character of your assets is essential to your estate plan. The title “ownership” is important for tax and transfer matters. The “value” is needed to determine potential tax liability. The “character” is needed to assess the manner by which the asset can transfer.

INSTRUCTIONS FOR COMPLETING THE ASSET ASSESSMENT SECTION

General Headings

This Asset Assessment section is designed to help you list all the property you own and what it is worth. If you do not own property under a particular heading, just leave that section blank. Under certain headings you may own more property than can be listed on this checklist.

Type

Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading.

“Owner” of Property

The way your property is titled is extremely important for purposes of properly designing and implementing your estate plan. For each property, please indicate how the property is titled. When doing so, please use the following abbreviations:

REAL PROPERTY

Any interest in real estate including your family residence, vacation home, time share, or vacant land.

Real Property #1:

Yes

Real Property #2:

Yes

Real Property #3:

Yes

Real Property #4:

Yes

Total Market Value:

$____________

Loan Balance:

$____________

FURNITURE AND PERSONAL EFFECTS

List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (give lump sum value for miscellaneous less separately listed valuable items).

Furniture and Personal Effects #1:

Yes

Furniture and Personal Effects #2:

Yes

Furniture and Personal Effects #3:

Yes

Furniture and Personal Effects #4:

Yes

Total Market Value:

$_______________

AUTOMOBILES, BOATS, AND RVs

For each motor vehicle, boat, RV, etc.

Vehicle #1:

Yes

Vehicle #2:

Yes

Vehicle #3:

Yes

Total Market Value:

$_______________

Total Loan Balance:

$_______________

BANK & SAVINGS ACCOUNTS

Type: Checking Account “C”, Savings Account “S”, Certificates of Deposit “CD”, Money Market “MM” (IRAs and 401(k)s listed below) NOTE: If Account is in your spouse’s name for the benefit of a minor, please specify minor’s name.

Bank and Savings Account #1:

Yes

Bank and Savings Account #2:

Yes

Bank and Savings Account #3:

Yes

Bank and Savings Account #4:

Yes

Bank and Savings Account #5:

Yes

Total:

$________________

INVESTMENT ACCOUNTS, BONDS, STOCKS, AND STOCK OPTIONS

List any and all investment accounts (IA), bonds (B), stocks (S) and stock options (SO) you have an interest in. If including stock options, please indicate value of vested and unvested options separately. If held in a brokerage account, lump them together under each account.

Investment Account, Bond, Stock or Stock Option #1:

Yes

Investment Account, Bond, Stock or Stock Option #2:

Yes

Investment Account, Bond, Stock or Stock Option #3:

Yes

Investment Account, Bond, Stock or Stock Option #4:

Yes

Investment Account, Bond, Stock or Stock Option #5:

Yes

Total Amount:

$________________

LIFE INSURANCE POLICIES AND ANNUITIES

Types: Term (T), Whole Life (WL), Split Dollar (SD), Group Life (GL), Annuity (A).

Policy #1:

Yes

Insurance Company: Type: Face Amount:

(death benefit)

Whose Life is Insured: Who owns the policy: The Current Beneficiaries: Who pays the premium: Who Is The Life Insurance Agent:

Policy #2:

Yes

Insurance Company: Type: Face Amount:

(death benefit)

Whose Life is Insured: Who owns the policy: The Current Beneficiaries: Who pays the premium: Who Is The Life Insurance Agent:

Policy #3:

Yes

Insurance Company: Type: Face Amount:

(death benefit)

Whose Life is Insured: Who owns the policy: The Current Beneficiaries: Who pays the premium: Who Is The Life Insurance Agent:

Policy #4:

Yes

Insurance Company: Type: Face Amount:

(death benefit)

Whose Life is Insured: Who owns the policy: The Current Beneficiaries: Who pays the premium: Who Is The Life Insurance Agent:

Total Face Amount:

$_____________

RETIREMENT PLANS

Pension (P), Profit Sharing (PS), H.R.10, IRA, SEP, 401K

Retirement Plan #1:

Yes

Retirement Plan #2:

Yes

Retirement Plan #3:

Yes

Retirement Plan #4:

Yes

Total Current Value:

$___________________

BUSINESS INTERESTS

General and Limited Partnerships (GL), Sole Proprietorships (SP), Privately Owned Corporations (C), Oil Interests (O), Farm and Ranch Interests (F&R)

Business Interest #1:

Yes

Business Interest #2:

Yes

Business Interest #3:

Yes

Business Interest #4:

Yes

Total Estimated Value:

$__________________

MONEY OWED TO YOU

Mortgages or promissory notes payable to you, or other moneys owed to you

Money Owed to You #1:

Yes

Money Owed to You #2:

Yes

Money Owed to You #3:

Yes

Money Owed to You #4:

Yes

Total Current Balance:

$__________________

ANTICIPATED INHERITANCE, GIFT, OR LAWSUIT JUDGMENT

Gifts or Inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

Anticipated Inheritance, Gift, or Lawsuit Judgment:

Total Estimated Value:

$__________________

OTHER ASSETS

Other property is any property that you have that does not fit into any listed category

Other Asset #1:

Yes

Other Asset #2:

Yes

Other Asset #3:

Yes

Other Asset #4:

Yes

Other Asset #5:

Yes

Total Value:

$__________________

SUMMARY OF ASSETS

Real Property:

Yes

Furniture and Personal Effects:

Yes

Automobiles, Boats, and RVs:

Yes

Bank and Savings Accounts:

Yes

Bonds, Stocks, Stock Options:

Yes

Life Insurance and Annuities:

Yes

Retirement Plans:

Yes

Business Interests:

Yes

Money owed to you:

Yes

Anticipated Inheritance, Etc.

Yes

Other Assets:

Yes

Total Assets

CLIENT 1 - Total Assets:

$________________

CLIENT 2 - Total Assets:

$________________

JOINT - Total Assets:

$________________

Total of all 3 columns:

$________________

E-Affirmation

E-Affirmation:

The undersigned understands that Attorney will need to rely on the asset and debt information supplied by you to develop an estate plan. The undersigned also understands that inaccurate or incomplete information could negatively impact the designed estate plan. Consequently, if Attorney is retained, you will need to provide us with complete and accurate information prior to the signing of any estate planning documents.

STEP 4: PEOPLE WHO ADVISE YOU

Your various advisors play a key role in the establishment of your estate plan. For example, your financial advisor and life insurance agent may need to be contacted to confirm/change beneficiary designations and titling of accounts.

Accountant/Tax Advisor:

Yes

Financial Advisor:

Yes

Life Insurance Agent:

Yes

Family Law Attorney:

Yes

Other Advisor:

Yes

Other Advisor:

Yes

Other Advisor:

Yes

STEP 5: PEOPLE TO INVOLVE IN YOUR ESTATE PLAN

This section asks you to identify all potential fiduciaries (i.e. agents under power of attorney, personal representatives and trustees) and beneficiaries of your estate. NOTE: Listing a person or particular organization in this section is not a firm indication of your decision to provide for an individual or make a bequest. Rather, it is simply a way of identifying potential beneficiaries for discussion purposes.

Potential Individual Beneficiaries – Primary Beneficiaries

Primary Beneficiary #1:

Yes

Primary Beneficiary #2:

Yes

Primary Beneficiary #3:

Yes

Primary Beneficiary #4:

Yes

Primary Beneficiary #5:

Yes

Primary Beneficiary #6:

Yes

Primary Beneficiary #7:

Yes

Potential Individual Beneficiaries – Alternate Beneficiaries

Alternate Beneficiary #1:

Yes

Alternate Beneficiary #2:

Yes

Alternate Beneficiary #3:

Yes

Alternate Beneficiary #4:

Yes

Alternate Beneficiary #5:

Yes

Alternate Beneficiary #6:

Yes

Alternate Beneficiary #7:

Yes

Potential Charitable/Non-Profit Beneficiaries – church, college, social club, favorite philanthropy, etc.

Potential Charitable/Non-Profit Beneficiary #1:

Yes

Potential Charitable/Non-Profit Beneficiary #2:

Yes

Potential Charitable/Non-Profit Beneficiary #3:

Yes

Potential Charitable/Non-Profit Beneficiary #4:

Yes

Potential Charitable/Non-Profit Beneficiary #5:

Yes

STEP 6: NOMINATION OF POWERS

Identify all potential Trustees, Executors, Financial Agents, Health Care Agents, Long-Term Guardians, Short-Term Guardians, and Guardians for Pets

LONG-TERM GUARDIAN FOR MINOR CHILDREN - [CLIENT 1]

If you have children under the age of 18, list those persons who you would wish to raise and love them in the manner closest to the way you do.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Back Up #3:

Yes

LONG-TERM GUARDIAN FOR MINOR CHILDREN - [CLIENT 2]

If you have children under the age of 18, list those persons who you would wish to raise and love them in the manner closest to the way you.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Back Up #3:

Yes

SHORT-TERM GUARDIAN FOR MINOR CHILDREN - [CLIENT 1]

If you have children under the age of 18, list those persons able to be immediately available to them if you could not be found.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Back Up #3:

Yes

SHORT-TERM GUARDIAN FOR MINOR CHILDREN - [CLIENT 2]

If you have children under the age of 18, list those persons able to be immediately available to them if you could not be found.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Back Up #3:

Yes

PERSONAL REPRESENTATIVE/EXECUTOR - [CLIENT 1]

Upon your death, who do you want to manage and distribute the assets you leave in your estate?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

PERSONAL REPRESENTATIVE/EXECUTOR - [CLIENT 2]

Upon your death, who do you want to manage and distribute the assets you leave in your estate?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

TRUSTEE - [CLIENT 1]

Upon your death, who do you want to manage and distribute the assets you leave in your trust estate for children?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

TRUSTEE - [CLIENT 2]

Upon your death, who do you want to manage and distribute the assets you leave in your trust estate for children?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

GUARDIAN FOR PETS - [CLIENT 1]

If you are interested in setting up a pet trust, please complete this section.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

GUARDIAN FOR PETS - [CLIENT 2]

If you are interested in setting up a pet trust, please complete this section.

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

FINANCIAL AGENTS - [CLIENT 1]

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your financial affairs?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

FINANCIAL AGENTS - [CLIENT 2]

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your financial affairs?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

HEALTH CARE AGENTS - [CLIENT 1]

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your health care?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

I Don't Know

Do you want to provide that your organs and tissues should be made available for transplant purposes?

Yes

I Don't Know

AUTHORIZED INFORMATION RECIPIENTS UNDER HIPAA - [CLIENT 1]

List any individuals you want to have access to your medical information. Any person named on this document will be able to receive information and discuss your condition with your doctor or nurse.

CLIENT 1 HIPAA Release: (provide legal names of all individuals you want listed on your HIPAA Release):

HEALTH CARE AGENTS - [CLIENT 2]

If you were incapacitated for any period of time, who would you want to make decisions for you with regard to your health care?

Initial Choice:

Yes

Back Up #1:

Yes

Back Up #2:

Yes

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

I Don't Know

Do you want to provide that your organs and tissues should be made available for transplant purposes?

Yes

I Don't Know

AUTHORIZED INFORMATION RECIPIENTS UNDER HIPAA - [CLIENT 2]

List any individuals you want to have access to your medical information. Any person named on this document will be able to receive information and discuss your condition with your doctor or nurse.

CLIENT 2 HIPAA Release: (provide legal names of all individuals you want listed on your HIPAA Release):

OTHER CONCERNS

Other Concerns (Please list below):

THANK YOU

When you are finished, please click the "Submit" button.