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:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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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:
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____________________________________________________________________________
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: _____________________________________________
OwnersForm 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