ESTATE PLANNING WORKSHEET 1. Personal Data Name _______________________ Address _____________________ ____________________________ County of Residence____________ Home Phone__________________ Work Phone __________________ Birthdate __________ Age ______ Employer ____________________ Retirement Date________________ Veteran: Yes ________ No _______ U.S. Citizen: Yes ______ No _____ Soc. Sec. No. __________________ 2. Marriage a. Date of Marriage: ____________ b. Have you or your spouse signed a Premarital Agreement? Yes _____ No______ If yes, please bring a copy of the document to the interview c. Have you or your spouse been divorced? Yes ___ No ___ Date of Divorce:________ If so, please bring a copy of the divorce decree to the interview. d. Have you or your spouse been widowed? Yes ___ No ____ Date of Death:_________ 3. Children Please list ALL your children, including deceased children, children born out of wedlock, and children you wish to omit from your estate plan. Name of Child Date of Birth Address Child of: Spouse __________________________ Address__________________________ ________________________________ County of Residence________________ Home Phone ______________________ Work Phone _______________________ Birthdate ________________ Age______ Employer _________________________ Retirement Date ____________________ Veteran: Yes ____________ No _______ U.S. Citizen: Yes _________ No ______ Soc. Sec. No. ______________________
a. Have any children received an advance on their inheritance or are any children financially indebted to you? If so, please explain. _______________________________ ________________________________________________________________________
b. Is there any reason NOT to treat your children equally? If so, please explain. _______ _______________________________________________________________________ c. Are any of the children under a disability? ___________________________________ d. Do you have any special concerns or objectives regarding your children? ___________ ________________________________________________________________________ e. Guardians. Who should be the guardian of your minor children? (A guardian has physical and legal control over your children until they reach the age of 18.) Name: _______________________________________________________ Address: ______________________________________________________ Alternate Guardian: _____________________________________________ Address: _______________________________________________________ 4. Personal Representative. Who should be Personal Representative (“executor”) of your estate? A Personal Representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate. Name: ________________________________________________________ Relationship to you: _____________________________________________ Address: _______________________________________________________ Alternate Personal Representative: __________________________________ Relationship to you: ______________________________________________ Address: ________________________________________________________ 5. Trusts. If a trust is appropriate to include in your estate plan, who should be the trustee? A trustee is the person or entity who is responsible for managing the assets placed into the trust. A trustee manages the assets for your children or other beneficiaries until they reach the specified ages. If you do not establish a trust, children inherit at age 18. You may name an individual, bank or trust or trust company, or both to act as your trustee. Name: ____________________________________________________ Address: __________________________________________________ Alternate Trustee: ___________________________________________ Address: __________________________________________________ 6. Attorney-in-Fact. It may be advantageous to name one or more persons to act with regard to your assets and finances when you are unable or unwilling to do so. Those persons are called attorneys-in-fact and are given that authority under a Power of Attorney. Name: ____________________________________________________ Address: __________________________________________________ Alternate Attorney-in-Fact: ____________________________________ Address: ___________________________________________________ Alternate Attorney-in-Fact: ____________________________________ Address: ___________________________________________________
7. Real Property Interests. a. Address: ____________________________________________________ Names as they appear on the deed: _______________________________ Legal Description: _____________________________________________ Date Acquired: _________________ Purchase Price: ________________ Current Market Value: ___________ Mortgage Balance: ______________ If rental property: Monthly rent received: __________________________ Monthly property tax: ____________________________________________ Monthly property insurance premium: _______________________________ Average monthly maintenance costs: ________________________________ b. Address: ____________________________________________________ Names as they appear on the deed: _______________________________ Legal Description: _____________________________________________ Date Acquired: _________________ Purchase Price: ________________ Current Market Value: ___________ Mortgage Balance: ______________ If rental property: Monthly rent received: __________________________ Monthly property tax: ____________________________________________ Monthly property insurance premium: _______________________________ Average monthly maintenance costs: ________________________________ c. Address: ____________________________________________________ Names as they appear on the deed: _______________________________ Legal Description: _____________________________________________ Date Acquired: _________________ Purchase Price: ________________ Current Market Value: ___________ Mortgage Balance: ______________ If rental property: Monthly rent received: __________________________ Monthly property tax: ____________________________________________ Monthly property insurance premium: _______________________________ Average monthly maintenance costs: ________________________________ 8. Other Assets. Asset Checking Account Savings Account Money Market Account Certificate of Deposit Savings Bonds Name of Owner Name of Beneficiary Basis Value Current Value
Treasury Notes Stocks Mutual Funds Life Insurance (Face) Retirement Accounts: IRA Pension Profit Sharing/401K Annuities Business Interests Homestead
TOTAL
9. Liabilities. Liabilities Home Mortgage Other Mortgage Debts To Family Members Other Debts (describe). Name of Owner Current Value
TOTAL LIABILITIES
10. Safe Deposit Box. Do you have a safe deposit box? Yes ____ No ____ If so, where? _______________ Does anyone else have access to your box? __________________________________ 11. Future Inheritances. Do you expect any inheritance in the near future? If so, please give details: __________ _______________________________________________________________________ 12. Monthly Income. Monthly Income Social Security Employment Pension from ______ Pension from ______ IRA’s, annuities, etc. Rents Business interests Interests & dividends Other ____________ TOTAL Husband Wife Joint
12. Financial Advisors. Accountant: _____________________________________________ Address: ________________________________________________ Telephone: ______________________________________________ Financial Advisor: ________________________________________ Address: ________________________________________________ Telephone: ______________________________________________
13. Special Requests. Special requests regarding funeral, cremation, or burial instructions are best handled by a Letter of Instruction or other statement (separate from your will) to your family or other responsible person. Organ donation is best handled in a Health Care Directive and noted on the person’s drivers license. 14. Discussion Issues. We will discuss the following issues at the meeting: • • • • • • • Current Will. Do you now have a will or a revocable trust? If so, bring copy to the interview meeting. Predeceased Child. If any child should predecease parent, should his/her share pass through to his/her children? If so, please indicate grandchildren, if any. Trusts. Do you wish to have a trust established for the benefit of your spouse and/or children? Specific Gifts. Do you wish to make any specific bequests to charities or individuals? No Family Survives. How should your estate be distributed if your spouse and/or children do not survive you? (For example: family, charity, etc.) If no Children. If you do not have children, to whom should your estate pass (beyond a spouse, if any)? Health care Directive. Are you interested in preparing a Health Care Directive appointing someone to make health care decisions for you and/or stating your preferences for health care? This document can also include instructions regarding organ donation. Power of Attorney. Are you interested in preparing a Power of Attorney granting another person the power to act on your behalf to manage your assets and pay your bills if you become incompetent or unable to sign your name? Loan Guarantees. Have you guaranteed any loans for your children, grandchildren or any other person? If so, bring details to the meeting.
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