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Estate Planning Information Worksheet

VIEWS: 9 PAGES: 3

									                                                               ESTATE PLANNING
                                                        INFORMATION WORKSHEET


                                  FAMILY DATA

First Name: _________________ Middle Initial: _____ Last Name: ____________________
Spouse’s First Name: _____________ Middle Initial: _____ Last Name: _________________

Mailing Address: _______________________________________________________________
Second Address: _______________________________________________________________

Contact Information:
Home phone: ___________________________ Work phone: ___________________________
Cell phone: ____________________________ Alt. phone: ____________________________
Email: _______________________________________________________________________
Spouse’s work number: _______________________ Spouse’s cell phone: ________________

Children:
How Many Together: ____; Just Husband’s: ____; Just Wife’s: ____;
1. Name: __________________________ Spouse’s Name: ____________________________
   Address: ___________________________________________________________________
   Home phone: ___________________________ Cell phone: _________________________
   Grandchildren: Names & Ages: ________________________________________________
   ___________________________________________________________________________

2. Name: __________________________ Spouse’s Name: ____________________________
   Address: ___________________________________________________________________
   Home phone: ___________________________ Cell phone: _________________________
   Grandchildren: Names & Ages: ________________________________________________
   ___________________________________________________________________________

3. Name: __________________________ Spouse’s Name: ____________________________
   Address: ___________________________________________________________________
   Home phone: ___________________________ Cell phone: _________________________
   Grandchildren: Names & Ages: ________________________________________________
   ___________________________________________________________________________

4. Name: __________________________ Spouse’s Name: ____________________________
   Address: ___________________________________________________________________
   Home phone: ___________________________ Cell phone: _________________________
   Grandchildren: Names & Ages: ________________________________________________
   ___________________________________________________________________________
U.S. Citizen: Wife: Y / N; Husband: Y / N
Florida resident: Wife: Y / N; Husband: Y / N
County of Residence: Charlotte/Sarasota/Other: ______________

                                             ASSETS

Liquid Assets: cash (dividends, etc.); savings accounts; checking accounts; money market
accounts; certificates of deposit; mutual funds (please bring recent statement if convenient):

        Item Identification                        How it’s owned                     Value
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________
_______________________________           _______________________________          $__________

Real Estate (if possible, please bring a copy of deeds):

          Property Address                       County/State            Value        Homestead
__________________________________            _____________/___       $_________        Y/N
__________________________________            _____________/___       $_________        Y/N
__________________________________            _____________/___       $_________        Y/N
__________________________________            _____________/___       $_________        Y/N


                                     SPECIFIC BEQUESTS

Animal(s): ____________________________________________________________________
Animal(s) w/cash: ______________________________________________________________
Cash to One Person: To whom: _________________________ Amount: $________________
Cash to Several People: To Whom: ______________________ Amount: $________________
                        To Whom: ______________________ Amount: $________________
                        To Whom: ______________________ Amount: $________________
                        To Whom: ______________________ Amount: $________________
Cash to Charity: ______________________________________ Amount: $________________

Burial Instructions (Provide name and address of crematory or cemetery):
______________________________________________________________________________
______________________________________________________________________________
                                       FIDUCIARY(S)

Please list names, addresses, phone numbers and relationship of those you are considering
naming as trustee, personal representative, power of attorney or health care surrogate.

Name: _________________________________________ Relationship: _________________
Address: _____________________________________________________________________
Phone numbers: _______________________________________________________________

Name: _________________________________________ Relationship: _________________
Address: _____________________________________________________________________
Phone numbers: _______________________________________________________________

Name: _________________________________________ Relationship: _________________
Address: _____________________________________________________________________
Phone numbers: _______________________________________________________________

Name: _________________________________________ Relationship: _________________
Address: _____________________________________________________________________
Phone numbers: _______________________________________________________________

								
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