ESTATE PLANNING QUESTIONNAIRE
Please complete this questionnaire. If you will spend the time to complete all items, you will give us the background information necessary to begin to understand the details and complexity of your estate. All information will be held in strict confidence. Please give your full name, date and place of birth, and Social Security number. Name: ________________________________________________________________________ (first) (middle) (last) (maiden)
Date and place of birth:____________________________________________________________ (date) (place) Social Security Number: ___________________________________________________________ Driver’s license number, State:_______________________________________________________ Where are you living now? Address: City, State, Zip: Please give your residence telephone number: Pager Please complete the following concerning your employment: Employer: Job Title: Type of work: Street address: City, State, Zip: Telephone number: Gross salary per month or annually: Length of employment: Education: Have you ever executed a will prior to this one? ________________________________________________ What is your marital status? If you are divorced, when and where did the divorce take place? When: Where:
Estate Planning Questionnaire 1
Cellular phone
If you are separated, who is your spouse? Where do they live? When did you separate? Name: Address: Date of Separation: Do you have any children? If yes, please list their full names, addresses, phone numbers and relationship to you (i.e., full blooded, step, etc…).
NAME
ADDRESS
COUNTY
PHONE
RELATIONSHIP
Do you want to include children born after the execution of this document? _________________________ Whom do you wish to receive ALL of your property (both real and personal)? Name: Address: Relationship to you? _________________________________________________________
If you desire to leave specific property to certain person(s), please list the property (real or personal) and the person(s) to inherit it – include their names, addresses, phone numbers and their relationship to you. NAME ADDRESS/ COUNTY PHONE RELATIONSHIP PROPERTY
Estate Planning Questionnaire 2
Who do you wish to be the Executor/Executrix of your estate? (I.e., who will be in charge of distributing your property? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________ Who do you wish to be an Alternate Executor/Executrix of your estate? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
If either the primary or alternate Executor/Executrix lives out of state, designate a person who lives in Texas to receive service of process. Name: Address: City, State, Zip: Relationship to you? _________________________________________________________ Do you want you Executor (-trix) to function independently of the court? ___________________ Do you want your Executor (-trix) to function without posting a bond? _____________________________ Who do you want to designate as a Guardian of your person? (I.e., who will take care of feeding/clothing you should you become unable to do so? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Who do you want to appoint as Alternate Guardian of your person? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Estate Planning Questionnaire 3
Who do you want to designate as a Guardian of your estate? (I.e., who will take care of your business affairs should you become unable to do so?) Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Who do you want to appoint as an Alternate Guardian of your estate? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Who do you wish to have as a Durable Power of Attorney over your estate? (I.e., who will take care of your business affairs should you become unable to do so?) Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Who do you wish to have as Alternate Powers of Attorney over your estate? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
When do you want the Durable Power of Attorney to become effective? (I.e., immediately or upon your disability?) ______________________________________________________________________________________
Estate Planning Questionnaire 4
Who do you want to designate as your Agent for Health Care Power of Attorney? (I.e., who will make your health care decisions for you should you become unable to do so?) Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Who do you wish to designate as your Alternate Agent for Health Care Power of Attorney? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________
Do you want life support if death is imminent and it would only serve to artificially prolong the moment of death? Yes _______ No _______ Do you want to give your Agent for Health Care any of the following powers: To have a feeding tube removed? To have IV’s removed? To have a breathing machine removed? Yes _______ Yes _______ Yes _______ No _______ No _______ No _______
Who do you want to handle your funeral arrangements? Name: Address: City, State, Zip: Relationship to you? _________________________________________________________ Yes _______ No _______
Have you made pre-arrangements with a funeral home?
If so, please provide the following information about the establishment: Name: Address: City/County/State/Zip: Do you wish to be cremated? Yes _______ No_______
Estate Planning Questionnaire 5
GUARDIANSHIP FOR MINOR CHILDREN
Identify all Minor Children:
Name Address Phone Date of Birth Social Security No.
Name of persons you wish to designate to care for your child(ren) in the event you are no longer able to do so:
Name: Address: City, State, Zip: Relationship to you? First Alternate: Name: Address: City, State, Zip: Relationship to you? Second Alternate: Name: Address: City, State, Zip: Relationship to you? _________________________________________________________ _________________________________________________________ _________________________________________________________
Estate Planning Questionnaire 6