WILL AND ESTATE PLANNING QUESTIONAIRE

WILL AND ESTATE PLANNING QUESTIONAIRE PLEASE FILL OUT ALL APPLICABLE SECTIONS [ALL INFORMATION YOU PROVIDE WILL BE KEPT CONFIDENTIAL AND WILL NOT BE DISCLOSED EXCEPT AS REQUIRED BY LAW. IF IT BECOMES NECESSARY TO DISCLOSE ANY FINANCIAL OR OTHER INFORMATION TO A COURT, WE WILL REQUEST THAT SUCH INFORMATION IN THE COURT RECORD BE SEALED TO PREVENT DISCLOSURE TO THIRD PARTIES] DATE : _________________ A. PERSONAL INFORMATION 1. FULL NAME(S): (HUSBAND): ___________________________________________________ (WIFE): _________________________________________________________ (SINGLE/ DIVORCED/WIDOWED):__________________________________________ _ ADDRESS: _____________________________________________________ _____________________________________________________ CITY/STATE/ZIP__________________________________________________ LIVING CHILDREN (INCLUDING THOSE LEGALLY ADOPTED) NAME DATE OF BIRTH MARITAL STATUS PROFESSION/BUSI NESS SPOUSE’S NAME IS CHILD FROM PRIOR MARRIAGE? Y OR N DECEASED CHILDREN AND THEIR ISSUE (IF YOU NEED ADDITIONAL SPACE, PLEASE INPUT ON SEPARATE PAGE) NAME OF DECEASED CHILD NAME(S) OF CHILD(REN) OF DECEASED CHILD LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com TEL (301)595-3241 Email: juanita.board@lboardlaw.com OTHER DEPENDANTS NAME DATE OF BIRTH MARITAL STATUS PROFESSION/BUSINESS SPOUSE’S NAME DATE OF BIRTH: (HUSBAND): _______________________________ (WIFE):_____________________________________ (SINGLE):__________________________________ DATE OF MARRIAGE: _______________________ LOCATION OF MARRIAGE (COUNTY/STATE)_____________________________ YEAR MARYLAND RESIDENCY ESTABLISHED___________________________ CITIZENSHIP: (SINGLE)__________ HUSBAND___________ WIFE__________ EVER LIVE IN A COMMUNITY PROPERTY STATE: YES [ ] NO [ ] IF YES, WHICH STATE(S) AND WHICH PERIOD(S) OF TIME:_________________ ______________________________________________________________________ ____ 2. BUSINESS ADDRESS/TELEPHONE.FAX/EMAIL: HUSBAND WIFE SINGLE BUSINESS ADDRESS BUSINESS TELEPHONE FAX EMAIL DESCRIPTION OF BUSINESS/PROFESSION TEL (301)595-3241 Email: juanita.board@lboardlaw.com LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com 3. GRANDCHILDREN: BIRTHDATE NAME OF PARENT NAME OF GRANDCHILD 4. HUSBAND LIVING PARENTS: WIFE SINGLE 5. BROTHERS AND SISTERS HUSBAND WIFE SINGLE 6. HUSBAND SOCIAL SECURITY NUMBER(S) WIFE SINGLE 7. DO YOU HAVE VETERAN STATUS? IF SO COMPLETE BELOW HUSBAND WIFE SINGLE SERVICE NUMBER: VA NUMBER: SERVICE RELATED DISABILITY “Y” OR “N” BRIEFLY TEL (301)595-3241 Email: juanita.board@lboardlaw.com LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com DESCRIBE 8. SAFE DEPOSIT BOX HUSBAND LOCATION WHO HAS ACCESS TO SAFE DEPOSIT BOX? 9. DO YOU AND/OR YOUR SPOUSE HAVE A WILL, POWER OF ATTORNEY, &/OR HEALTH CARE DIRECTIVE/LIVING WILL ?(INDICATE BY A “YES” OR “NO”) IF YES, ATTACH A COPY OF THE DOCUMENT(S) TO THIS QUESTIONNAIRE. HUSBAND WIFE SINGLE WIFE SINGLE 10. HUSBAND ANNUAL INCOME WIFE SINGLE B. ASSET INFORMATION DO YOU (PLEASE CHECK “YES” OR “NO” TO THE FOLLOWING): HUSBAND WIFE Expect to inherit something from parents or others? Y[ ] n[ ] Y[ ] n[ ] Expect to receive benefits from a retirement plan? Y[ ] n[ ] Y[ ] n[ ] Have powers of appointment? Y[ ] n[ ] Y[ ] n[ ] Expect to receive gifts from parents or others? Y[ ] n[ ] Y[ ] n[ ] Are you a beneficiary under a trust? Y[ ] n[ ] Y[ ] n[ ] Have an interest in a buy-sell agreement? Y[ ] n[ ] Y[ ] n[ ] Expect to receive any other benefits? Y[ ] n[ ] Y[ ] n[ ] do you have a marriage (prenuptial) agreement? Y[ ] n[ ] Y[ ] n[ ] do you have a separation/property settlement agreement? Y[ ] n[ ] Y[ ] n[ ] 1. 2. REAL ESTATE TYPE (I.E. APPROXIMATE HOME, LAND, MARKET VALUE ETC.) PURCHASE DATE SINGLE Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] Y[ ] n[ ] LOCATION (city/county/state) HOW IS PROPERTY TITLED? TEL (301)595-3241 Email: juanita.board@lboardlaw.com LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com 3. LIFE INSURANCE Death benefit Approximate cash value Person insured Owner of policy Beneficiary of policy Company & policy number 4. CASH ACCOUNTS APPROXIMATE BALANCE NAME(S) ON ACCOUNT HOW IS ACCOUNT TITLED (e.g. JOINT, POD, ETC.) NAME & ADDRESS OF INSTITUTION 5. SECURITIES NUMBER OF SHARES ORIGINAL APPROX COST MARKET VALUE DATE OF IN PURCHASE WHOSE NAME? NAME & ADDRESS OF COMPANY 6. PESONAL PROPERTY (PLEASE PROVIDE ADDITONAL PROPERTY ON SEPARATE SHEET OF PAPER) DESCRIPTION ORIGINAL COST FAIR MARKET TEL (301)595-3241 Email: juanita.board@lboardlaw.com LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com VALUE 7. TRUST DEEDS, NOTES, RETIREMENT PLANS, AND OTHER ASSETS: FAIR MARKET VALUE DESCRIPTION 8. DEBTS: TYPE OF DEBT AND TO WHOM OWED APPROX. AMOUNT OWED 9. [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] CHECKLIST-PLEASE PROVIDE COPIES OF THE FOLLOWING DOCUMENTS: Existing wills and trust agreements Real property deeds Deeds of trust and notes Partnership & corporate agreements and tax returns Retirement and deferred compensation agreements Life insurance policies Powers of attorney Most recently filed income tax returns (federal & state) Health care power of attorney (living wills) LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com TEL (301)595-3241 Email: juanita.board@lboardlaw.com C. WILL PROVISIONS DESIRED BY CLIENT 1. GENERAL DISPOSITION INFORMATION SPECIFIC BEQUESTS (WHAT PROPERTY DO YOU WANT TO GIVE TO SPECIFIC INDIVIDUALS AT DEATH?) Description of property Name of person to whom property should be distributed DISPOSITION OF RESIDUE OF ESTATE (remaining property after specific bequests are distributed. Sometimes a person wants the remainder of his/her estate, such as a home, to pass to a spouse or other individual outright or only for that person’s lifetime and then pass to other individuals, such as children. If you wish to make a lifetime bequest, you must indicate below, who is to be the ultimate beneficiary of the remainder of your estate): ___________________________________________________________________________ _______ ULTIMATE BENEFICIARY ________________________________________________________ ___________________________________________________________________________ ______ 2. PERSONAL REPRESENTATIVE/EXECUTOR ((it is advisable to have one (1) initial and at least two (2) alternate persons named) name Initial personal representative LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com Relationship to you TEL (301)595-3241 Email: juanita.board@lboardlaw.com 1st alternate personal representative 2nd alternate personal representative 3rd alternate personal representative 3. TRUSTEES OF TESTAMENTARY TRUST (IF any) (it is advisable to have one (1) initial and at least two (2) alternate persons named) name Initial trustee 1st successor trustee 2nd successor trustee 3rd successor trustee 4. GUARDIANS FOR MINOR CHILDREN (IF ANY) (until a child reaches the age of 18, that Relationship to you child must have a guardian appointed with respect to both their person and any property said child may inherit from you. If the other parent survives you, that parent is automatically named as guardian of the person of the children. However, you do not have to name the other parent as guardian of the children’s property. If neither parent survives, it is advisable to name at least two (2) people who can serve individually or jointly. name Initial guardian of the person 1st successor guardian 2nd successor guardian 3rd successor guardian Relationship to you name Initial guardian of the property 1st successor guardian 2nd successor guardian 3rd successor guardian D. Relationship to you DURABLE POWER OF ATTORNEY 1. this document authorizes someone (sometimes referred to as “attorney-in fact” or “agent”) to act for you if you should become incapacitated and unable to handle your personal financial affairs. If you are not married, use the sections allotted for husband or wife. Name/address/tel no (home & office) Relationship to you For husband Initial agent For wife Initial agent 1st successor agent LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com For husband TEL (301)595-3241 Email: juanita.board@lboardlaw.com For wife 1st successor agent 2nd successor agent 2nd successor agent For husband For wife 2. DURABLE HEALTH CARE POWER OF ATTORNEY this document authorizes someone (referred to as “health care agent”) to act for you if you are unable to make decisions affecting life sustaining and other health matters.) If you are not married, use the sections allotted for husband or wife. Name/address/tel no Relationship to (home & office) you For husband Initial agent For wife Initial agent 1st successor agent 1st successor agent 2nd successor agent 2nd successor agent For husband For wife For husband For wife TEL (301)595-3241 Email: juanita.board@lboardlaw.com LAW OFFICE OF L. JUANITA BOARD, LLC 4412 POWDER MILL ROAD, SUITE 200 •BELTSVILLE, MD 20705-2762 facsimile (301) 595-3243 www.lboardlaw.com