index by HC111110235822

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									                                   ASSET INVENTORY


  Bank Name and Address                     Form of Account
      Account Number                   (Joint, Tentative Trust, etc.)       Amount
                                           Names of Account
_________________________              ____________________             $_____________
_________________________              ____________________             $_____________
_________________________              ____________________             $_____________
_________________________              ____________________             $_____________
_________________________              ____________________             $_____________


                                                                  Total: $_____________


Enter here information pertinent to estate planning decisions:
______________________________________________________________________
______________________________________________________________________


Are these permanent savings accounts or suspense accounts pending use of funds for other
purposes?


______________________________________________________________________
______________________________________________________________________


                                    U.S. SAVINGS BONDS


Registration of Bonds               Total Redemption Value of             Issue Dates
 (Form and Names)                      Bonds So Registered
___________________                    _________________                ______________
___________________                    _________________                ______________
___________________                    _________________                ______________
                               Total: __________________


Enter here information pertinent to estate planning decisions:
______________________________________________________________________
______________________________________________________________________


What amounts were contributed by each co-owner?


______________________________________________________________________
______________________________________________________________________


                                       OTHER BONDS


 Description                                      Cost
   (Issuer                                          or
 Series, Rate,        Registration of Bonds       Face            Other        Current
 Date Acquired)        (form and Names)         Amount            Basis         Value
______________      __________________        $__________        ________   $_____________
______________      __________________        $__________        ________   $_____________
______________      __________________        $__________        ________   $_____________
______________      __________________        $__________        ________   $_____________
______________      __________________        $__________        ________   $_____________
______________      __________________        $__________        ________   $_____________


                            BOND TOTAL: $_________                 TOTAL: $_____________


Enter here information pertinent to estate planning decisions:


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


What amounts were contributed by each joint owner?
____________________________________________________________________________
____________________________________________________________________________


Any U.S. Treasury bonds redeemable at par to pay Federal Estate tax?


____________________________________________________________________________
____________________________________________________________________________


                                           STOCKS


Name of Company and Type of Stock: ___________________________________________


Number of Shares: ___________________________________________________________


Registration of Stock (Form and Names): _________________________________________


Date Acquired: ______________________________________________________________


Cost or Other Basis: __________________________________________________________


Current Value: ______________________________________________________________


Enter here information pertinent to estate planning decisions:


____________________________________________________________________________
____________________________________________________________________________


Is portfolio active or stable?


____________________________________________________________________________
Is purpose of investment program primarily current income or capital appreciation?


____________________________________________________________________________
____________________________________________________________________________
Do you have margin account? Cash account?


____________________________________________________________________________
____________________________________________________________________________


What amounts were contributed by each joint owner of jointly held stock?


____________________________________________________________________________


List also other property interests in this area such as warrants, etc.


____________________________________________________________________________


List all brokers with whom you have account or do business.


____________________________________________________________________________


                                  REAL ESTATE RESIDENCES


Location Description, Date Acquired: _____________________________________________


OwnersForm of Ownership-Interest of Each Owner: _______________________________
____________________________________________________________________________


Cost or Other Basis: ___________________________________________________________


Fair Market Value: ____________________________________________________________
Mortgages and Other Liens: _____________________________________________________


Your Equity: _________________________________________________________________


TOTAL: __________________________
                                  INSURANCE ON HOMES


Type of Insurance       Name of Company         Policy Number    Expiration   Name of
                                                                  Dates        Broker
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________
_______________       ________________         ______________ __________ ___________


Enter here information pertinent to estate planning decisions:


____________________________________________________________________________
____________________________________________________________________________


What amounts were contributes by each joint owner?


____________________________________________________________________________
____________________________________________________________________________


Do you contemplate any sales of above homes in near future?


____________________________________________________________________________


                                REAL ESTATE-INVESTMENTS


               Owners-Form of                                    Mortgages
  Location     Ownership-Inter-      Cost or         Fair          and
 Description    est of Each           Other         Market         Other       Your
 Date Acq’d         Owner             Basis          Value         Liens      Equity
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________


                                                                  TOTAL: _________________


                           INSURANCE ON INVESTMENT REALTY


Type of Insurance        Name of             Policy             Expiration     Name of Broker
                        Company             Number                Dates
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________
______________       _____________       _____________         _____________   _____________


Enter here all information pertinent to estate planning decisions:


____________________________________________________________________________


Is investment realty owned by corporation in which you hold stock?


______________________________________________________________________


If so, give details concerning corporation and stockholders.


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
                                 NON BUSINESS RECEIVABLES


  Debtor        Nature of Debt      Security           Date Due   Face Amount Current Value
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________
___________ ___________ ___________ ___________ ___________ ___________


                                                                       TOTAL: ___________


Enter here other pertinent information:


____________________________________________________________________________


List any surety or accommodation parties regarding any of the above debts; how payable; names
of associates holding interests in receivables, etc.
____________________________________________________________________________


                                         LIFE INSURANCE


List all policies under which you are the insured.


                                            Present                     How will
  Name of        Type of        Policy         Cash       Face           Proceeds
  Company         Policy      Number        Value       Amount Owner     Be Paid Beneficiary
__________ _________ _________ _______ ________ _______ _______ _________
__________ _________ _________ _______ ________ _______ _______ _________
__________ _________ _________ _______ ________ _______ _______ _________
__________ _________ _________ _______ ________ _______ _______ _________
__________ _________ _________ _______ ________ _______ _______ _________
__________ _________ _________ _______ ________ _______ _______ _________


                                       _________ _________
                                                 TOTALS


Enter here information pertinent to estate planning decisions:


____________________________________________________________________________


Are there any loans under policies?


____________________________________________________________________________


Have any policies been assigned?


____________________________________________________________________________


Should you reconsider settlement chosen?


___________________________________________________________________________
Do you own life insurance on lives of others? If so, give details here including name of insured,
face amount of policy, and present cash value.


____________________________________________________________________________
____________________________________________________________________________


Who are insurance agents with whom you deal with ?


____________________________________________________________________________




BUSINESS INTERESTS


Name of Business: ____________________________________________________________
Address of Business: __________________________________________________________


Sole proprietorship: _______ Partnership: _______ Close Corporation: __________


Nature of Business enterprise: ___________________________________________________


Names of Partners         Number of Shares or              Office Held     Duties
or Stockholders            Percentage Interest
__________________       _________________ ________________              ___________
__________________       _________________ ________________              ___________
__________________       _________________ ________________              ___________
__________________       _________________ ________________              ___________
__________________       _________________ ________________              ___________
__________________       _________________ ________________              ___________


Value of interest in business: _____________________________________


Have you entered in to any partnership, stockholders’, cross-purchase, or stock redemption
agreement? If so, describe briefly on this page.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Are there IRC Sec. 303 stock redemption considerations?


____________________________________________________________________________


Have you retained voting rights in transferred stock? [IRC Sec. 2036 (b)].


____________________________________________________________________________


If no agreement presently exists, what are your wishes with regard to business interests?
____________________________________________________________________________


Enter on this page information on family members and key men who can operate business in the
event of your death or disability and other facts relating to plans for retention or disposition of
business interest?


____________________________________________________________________________


List facts relating to capital structure of corporation. Does corporation hold treasury stock? Has
all authorized stock been issued, etc.?


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


                          EMPLOYEE AND RETIREMENT BENEFITS


Employer’s Pension, Profit-sharing or Stock Bonus Plans


                       Plan 1                      Plan 2                         Plan 3
Name of Plan _________________              _________________              _________________


Trustee, Insurance
Company, or
Administrator _________________             _________________              _________________


Amount Contributed
by Employee _________________               _________________              _________________


Amount Contributed
by Employer _________________               _________________              _________________


Retirement
Benefit        _________________          _________________            _________________


Death Benefit _________________           _________________            _________________


Present Value of Total
Contributions _________________           _________________            _________________


Amount Vested ________________            _________________            _________________


What are the options available to you? Enter here information pertinent to selection of options
offering you maximum advantage for your situation, e.g., payment of lump sum, payment in
installments, payment in company stock, payment in the form of an annuity.


____________________________________________________________________________
Can you borrow from plan? What amounts can you presently withdraw?


___________________________________________________________________________


Retirement Benefit Plans


Are you contributing to an IRA? If self-employed -- to a Keogh plan?


____________________________________________________________________________
____________________________________________________________________________


Group Life, Accident, Health, Death Benefit, and Disability Plans


                              Plan 1                   Plan 2                  Plan 3
Name of Plan          __________________ ___________________ ________________


Insurer of Trustee    __________________ ___________________ ________________


Policy Number         __________________ ___________________ ________________
Benefits               __________________ ___________________ ________________


Beneficiary            __________________ ___________________ ________________


Options Elected        __________________ ___________________ ________________


What other options are available to you?


____________________________________________________________________________


Split-Dollar Life Insurance


Enter here all information relating to split-dollar life insurance, e.g., name of company, policy
number, form of agreement, face amount, net amount payable to beneficiary.


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Stock Options


Enter her all pertinent information relating to stock options held by you, e.g., option price,
number of shares to which options extends, number of shares already purchased, price at which
purchased, present market value per share, etc.


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Deferred Compensation Contract


Date of execution; provisions for retirement and death benefits.
____________________________________________________________________________


TOTAL DEATH BENEFITS FROM ALL PLANS ___________________


                      RIGHTS UNDER ESTATES AND TRUSTS INCLUDING
                                POWERS OF APPOINTMENT


Rights and interest of trusts set up by yourself


Date trust executed: ___________________________________________________________


Name and address of trustee: ____________________________________________________


Duration of trust: _____________________________________________________________


Value of initial corpus on date of transfer to trustee: _________________________________


Present market value of total corpus: ______________________________________________


Rights and interests held by settlor (if none, so state): ________________________________
____________________________________________________________________________


Is trust revocable?
____________________________________________________________________________


Rights and interests of other beneficiaries (describe briefly; examine copy of trust instrument):


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Details on your powers of appointment:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Rights and interest of your trusts set up by others: ___________________________________
____________________________________________________________________________


Type of trust: Inter vivos ______________   Testamentary _____________________


Name of settlor: ______________________________________________________________


Name and address of trustee: ____________________________________________________


Date trust executed if inter vivos: ________________________________________________


Date will probated if testamentary: _______________________________________________


Court having supervision of trust: ________________________________________________


Duration of trust: _____________________________________________________________


Present market value of trust corpus: ______________________________________________


Rights and interest held by you: _________________________________________________


Is trust revocable? ____________________________________________________________


Rights and interests of other beneficiaries: _________________________________________
____________________________________________________________________________


Details on your power of appointment: ___________________________________________
____________________________________________________________________________
                                        MISCELLANEOUS ASSETS


Personal Property
(Automobiles, boats, jewelry, furs, silverware, china, art works, books, stamp collections, coin collections,
household furniture, etc.)


    Description              Location      Current Value             Costs or               Insurance
  Date Acquired                                                   Other Basis             Information
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________
______________         ____________ ____________                 ___________           _______________


                         SUBTOTAL: ____________


Patents, Copyrights, Trademarks


Enter here information pertinent to estate planning decisions, e.g.,
annual income over last few years, anticipated income to expiration date, etc.


____________________________________________________________________________
____________________________________________________________________________


Oil and Gas Interest


List all transfers that might be included in gross estate (gifts where donor retained some control,
transfers for inadequate consideration, etc.). Examine copies of all gift tax returns:
How much unified credit remains for you and your spouse?
____________________________________________________________________________
____________________________________________________________________________


Rights Under Estates Being Administered and Anticipated Inheritances
Enter here all pertinent information:


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Safe Deposit Boxes


Name of safe deposit company, address, box number, names and addresses of persons having
access, form of registration. Is property of any person in box?


____________________________________________________________________________
____________________________________________________________________________


Cemetery Plots


Enter here all information relating to ownership of family burial plots, location of deed.


____________________________________________________________________________
____________________________________________________________________________


Other Assets Not Previously Listed


____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
TOTAL - MISCELLANEOUS ASSETS: ____________
LIABILITIES


  Nature of              Creditor     Amount      Security        Location of
    Debt                                                            Security
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________
__________            __________     __________   ________     _______________


                               TOTAL _____________


                                    SUMMARY SHEET


Assets


Bank Accounts:                                    ________________________________


Bonds (Total U.S. Savings Bonds and others): ________________________________


Stocks:                                           ________________________________


Real Estate - Residences:                         ________________________________


Real Estate - Investments:                        ________________________________


Non Business receivables:                         ________________________________


Life Insurance on your life:                      ________________________________
Life insurance on lives of others:                  ________________________________


Business interests:                                 ________________________________


Death Benefits - Employee and Retirement plans:     ________________________________


Rights under estates and trusts including powers
of appointment:                                     ________________________________


Miscellaneous assets:                         ________________________________


ESTIMATED GROSS ESTATE                        TOTAL: ______________________________


***DOCUMENTS CHECKLIST (to be examined by attorney as required) AND LOCATION-OTHER
REQUIRED INFORMATION***


Document                                            Location


Previous will or wills:                             ________________________________


Spouse’s will:                                      ________________________________


Antenuptial agreement:                              ________________________________


Copies of income and gift tax returns:        ________________________________


Birth Certificates:                                 ________________________________


Marriage Certificates:                              ________________________________


Divorce Decree:                                     ________________________________


Separation Agreement:                               ________________________________
Family Tree:                                       ________________________________


Military service discharge certificate and
benefits records:                                  ________________________________


Social Security number:                            ________________________________


Person holding safe deposit keys:                  ________________________________


Cemetery deed:                                     ________________________________


Name and address of insurance agent:         ________________________________


Name and address of stockbroker:                   ________________________________


Leases:                                            ________________________________


Deeds of residence and business property:          ________________________________


Tax receipts:                                      ________________________________


Maps, surveys:                                     ________________________________


Mortgages and notes owned:                         ________________________________


Mortgages and notes owed:                          ________________________________


Stock and bond certificates:                       ________________________________


Bankbooks and bank statements:                     ________________________________
Records of securities purchased and sold:          ________________________________


Life insurance and annuity policies:               ________________________________
Fire and other casualty insurance policies:             ________________________________


Health and accident policies:                           ________________________________


Partnership agreement:                                  ________________________________


Stockholders’ agreement:                                ________________________________


Stock redemption agreement:                             ________________________________


Business continuation agreement:                        ________________________________


Business legal and accounting records:                  ________________________________


Employee benefit plan booklets, records
agreements, certificates, account books:                ________________________________


Deferred compensation agreement:                        ________________________________


Copies of trust agreements and wills under which
you have power of appointment and other rights:         ________________________________


Trust instruments in which you are settlor:             ________________________________


Bills of sale and other evidences of ownership:         ________________________________


  The Asset Inventory Form needs to be used with the Estate Analysis Form found in the Financial
                                         Planning Category

								
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