The information you collect in this questionnaire can be useful to help you organize personal and financial information so that you can assess your current estate plans and evaluate whether changes are desired or required. This information can also be useful to provide your estate planning attorney with the information needed to make a similar analysis.
Name, address, citizenship, date of birth and contact information for your and your spouse.
Time saving tip: State the names requested below exactly as you want them to appear in your will and other estate planning documents.
Your name:
Date of birth:
Spouse's name:
Date of birth:
Home Address:
Telephone:
Email:
Are you a United States citizen?
If not, of what country are you a citizen?
Is your spouse a citizen of the United States?
If not, of what country is he/she a citizen?
Your children, their spouses, and their children.
Indicate which, if any, of your children is your child but not your spouse's, or vice versa.
Also show the date and place of adoption of any adopted child.
Be sure to include any deceased child and indicate the date of the child's death and his or her surviving spouse and children. 1.(a) Child:___________________ Date of birth: ____________ (b) Personal data (specify is the child from prior marriage, adopted, deceased, etc.)
If either you or your spouse has been married previously, state the name of each prior spouse and indicate whether he or she is now living (if living give his or her address).:
If either you or your spouse has been divorced, attach a copy of the divorce decree.
Is there other important personal information that might affect your estate plans? For example, does a member of your family have a serious long-term medical or physical problem that will require special care or attention in the future?
Tip: See the article and video on financial planning for special needs children.
The
following questions do not require detailed responses. For example,
shares in publicly traded companies might be shown simply as "common
stocks." On the other hand, for property interests that are more or
less unique, such as interests in real estate, greater detail will
be helpful. With regard to real estate, it is important for your
lawyer to know the location (city and state) of the real estate, how
title is held, and the character of the property, e.g., residence,
shopping center, apartment house, or similar description. The
following abbreviations may be used to describe certain attributes
of particular assets: JT = Joint tenancy with right of survivorship
TE = Tenancy by the entirety TC = Tenancy in common H = Husband's
name alone W = Wife's name alone LT = Land trust FMV = Fair market
value (or your best estimate) CV = Cash value of life insurance
policy PV = Proceeds of life insurance policy 1. Personal residence:
Address: ______________________________________________ Description
(e.g., single family, condo, or co-op, similar description):
_________________________________ How you hold title: FMV:__
Mortgage balance, if any:______________ Mortgage life
insurance?__________________ 2. Other personal residences or
vacation homes: Address:
______________________________________________ Description (e.g.,
single family, condo, or co-op, similar description):
_________________________________ How you hold title: FMV:__
Mortgage balance, if any:______________ Mortgage life
insurance?__________________ 3. Personal and household effects: If
you think that the general categories do not provide an adequate
description, please provide additional detail. Also state your best
estimate of the value of each kind of property and who owns it (how
you hold title).
Automobiles:_______________________________________________ General
personal and household effects such as furniture, furnishings,
books, and pictures of no special value: _____
___________________________________________________________
___________________________________________________________ Valuable
jewelry (indicate if insured): ___________________
___________________________________________________________ Valuable
works of art (indicate if insured): ______________
___________________________________________________________ Valuable
antiques (indicate if insured): __________________
___________________________________________________________
___________________________________________________________ Other
valuable collections, e.g., coins, stamps, or gold (indicate if
insured):_____________________________________
___________________________________________________________
___________________________________________________________ Other
tangible personal property that does not seem to be covered by any
of the other categories: ___________________
___________________________________________________________
___________________________________________________________ 4. Cash,
cash deposits, and cash equivalents: State the name and address of
each bank or institution and who owns each item. (a) Checking
accounts, including money market
accounts:You:______________________________________________________
Spouse:___________________________________________________ Jointly
with:_____________________________________________ (b) Ordinary
savings
accounts:You:______________________________________________________
Spouse:___________________________________________________ Jointly
with:_____________________________________________ (c) Certificates
of
deposit:You:______________________________________________________
Spouse:___________________________________________________ Jointly
with:_____________________________________________ (d) Short-term
U.S. obligations
(T-bills):You:______________________________________________________
Spouse:___________________________________________________ Jointly
with:_____________________________________________ 5. Pension &
profit-sharing plans, IRAs, ESOPs or other tax-favored
employee-benefit plans. (a) Pension plans. You:___________________
Vested:____ Current value: _______ Spouse:________________
Vested:____ Current value: _______ (b) Profit-sharing plans.
You:___________________ Vested:____ Current value: _______
Spouse:________________ Vested:____ Current value: _______ (c)
Individual Retirement Accounts (IRAs). You:_________________________
Current value ______________ Spouse:______________________ Current
value ______________ (d) Other tax-qualified employee benefit plan
interests. Please provide similar information. ___________
__________________________________________________________ 6. Life
Insurance on your life. (a) Ordinary life insurance. List company,
name, address, and policy number.
__________________________________________________________
__________________________________________________________ Face
amount of policies (proceeds):_______________________ If you do not
own it, who does? __________________________ Beneficiaries:
___________________________________________ Cash value:_______
Loans, if any, against it: ____________ Amount of accidental death
benefits, if any:______________ (b) Term/group term insurance. List
company, name, address, and policy number.
__________________________________________________________
__________________________________________________________ Face
amount of policies (proceeds):_______________________ Owner other
than you:_____________________________________
Beneficiaries:____________________________________________
__________________________________________________________
Accidental death benefits:________________________________
__________________________________________________________ (c)
Please supply similar information with respect to other life
insurance or other insurance having life insurance
features:_______________________________________
__________________________________________________________ 7. (a)
Life insurance on your spouse's life. List company, name, address,
and policy number.________________
__________________________________________________________ Face
amount of ordinary life insurance:___________________ Owner other
than spouse:__________________________________
__________________________________________________________
Beneficiaries:____________________________________________ Cash
value:_______ Loans, if any:____________ Accidental death
benefits:___________________ (b)Term/Group life insurance. List
company, name, address, policy
number.___________________________________
__________________________________________________________ Face
amount of term/group term insurance:________ Owner other than
spouse:__________________________________
Beneficiaries:____________________________________________ Cash
value:_______ Loans, if any:____________ Accidental death
benefits:________________________________ (c) Other insurance on
spouse's life:______________
__________________________________________________________ 8.
Closely held business interests. Describe any interest you have in a
family or other business with limited shareholders. Include the
nature of the business, its form of organization (e.g., corporation,
partnership, or the like), whether you are active in its operations,
and your estimate of its value. If it is a corporation, please
indicate whether an "S election" is in force with respect to the
federal taxation of the corporation._______________
__________________________________________________________
__________________________________________________________
__________________________________________________________ With
respect to any such business, do you believe it would continue to
operate successfully in the event of your permanent absence from it
or the permanent absence of some other key person?
________________________________________
__________________________________________________________ 9.
Investment assets. With respect to each category, please state the
owner (how title is held) and the approximate value. (a) Publicly
traded stocks and corporate
bonds.You:______________________________________________________
Spouse:___________________________________________________ Jointly
owned with:_______________________________________ (b) Municipal
bonds.You:______________________________________________________
Spouse:___________________________________________________ Jointly
owned with:_______________________________________ (c) Long-term
U.S. Treasury Notes and
Bonds.You:______________________________________________________
Spouse:___________________________________________________ Jointly
owned with:_______________________________________ (d) Limited
partnership
interests.You:______________________________________________________
Spouse:___________________________________________________ Jointly
owned with:_______________________________________ (e) Other
investments. Please describe the general nature and value of other
investment
interests:You:______________________________________________________
Spouse:___________________________________________________ Jointly
owned with:_______________________________________ Other
interests of current or future value
1. Interests in
trusts. Describe any trusts created by you, by any other person,
such as a parent or ancestor, in which you or a member of your
immediate family has a right to receive distributions of income or
principal, whether or not such distributions are actually being
received or anticipated in the future. Be as specific as you can. If
possible, submit a copy of the trust agreement. If the trust
agreement is not available, show the date the trust was created,
whether it can be amended or changed, whether someone has a power of
appointment over it, when the trust terminates, and who will receive
the trust property upon termination. Also, state the approximate
current value of the trust and the annual income from it.
___________________________________________________________
___________________________________________________________ 2.
Anticipated inheritances. If you or any other members of your
immediate family are likely to receive substantial inheritances in
the foreseeable future from persons other than yourself or your
spouse, describe your best estimate of the value and the nature of
each inheritance.
___________________________________________________________
___________________________________________________________ 3. Other
assets or interests of value. Describe the general nature, form of
ownership, and your estimate of the value of any asset or interest
of value that does not seem to fit in any of the categories above.
__________________________________________________________
__________________________________________________________
Liabilities
Describe here substantial financial
liabilities not reflected in the asset information you have provided
above. If they are secured, indicate the nature of the security.
Also show any substantial contingent liabilities, such as personal
guarantees you have made on obligations of a business, a family
member, or any other person. Indicate whether you have insured
against any of these obligations in the event of your death, or if
the obligations do not survive your death.
1. How would you dispose of your estate at your death if there were no such thing as estate or inheritance taxes? __________________________________________________________ __________________________________________________________ __________________________________________________________ 2. In the event of your death, would your spouse or children be likely to receive income from sources other than your estate, such as the continuance or resumption by your spouse of his or her vocation or profession? __________________________________________________________ __________________________________________________________ __________________________________________________________ 3. Describe any personal objectives you have for your family and your estate that override possible adverse tax consequences arising from trying to achieve them. __________________________________________________________ __________________________________________________________ __________________________________________________________
1. Guardians for minor children. If you have minor children, you may designate in your will a guardian or guardians of the person and their estate in the event of your death and/or your spouse's. (a) Guardian of the person. Name(s):__________________________________________________ Address:__________________________________________________ (b) Guardian of the estate, if different. Name(s):__________________________________________________ Address:__________________________________________________ (c) Substitute guardian of the person. Name(s):__________________________________________________ Address:__________________________________________________ (d) Substitute guardian of the estate. Name(s):__________________________________________________ Address:__________________________________________________ 2. Executor. Your executor has the responsibility to wind up your affairs at your death, see to it that your assets are collected, that claims, expenses, and estate and inheritance taxes are paid, and then distribute your property to trustees or others you have named. It is a task of limited duration, substantial responsibility, and much work. (a) Principal executor. Name(s):__________________________________________________ Address:__________________________________________________ (b) Substitute executor. Name(s):__________________________________________________ Address:__________________________________________________ 3. Trustees. Your trustees have the responsibility for the long-range management of property that is to be held in trust for the benefit of the beneficiaries of trusts you may create. Depending on the terms of the trust, there may be adverse tax consequences if a trustee has an interest or possible interest in the trust, although usually if the trustee's discretion is limited those adverse tax consequences are similarly limited. A trustee can be a corporation (qualified to act) or individual. You may choose to have co-trustees, one of which may or may not be a corporation. Because corporate trustees must charge fees for their services, they may decline to accept small trusts. Their fees to administer a small trust may turn out to be disproportionately large if they are to cover their costs in handling the trust. In general, choose a trustee with the following qualities: integrity, mature judgment, fiscal responsibility, and reasonable business and investment acumen. If you wish to select co-trustees, you may want to choose them for how well their individual strengths compliment each other. Frequently, the same person(s) or corporation selected as executor(s) may be designated as trustee(s). (a) Principal trustees. Names:_____________________________________________________ ___________________________________________________________ Addresses:_________________________________________________ ___________________________________________________________ (b) Substitute trustees (to act if one or more of the principal trustees cannot or will not act). Names:_____________________________________________________ ___________________________________________________________ ___________________________________________________________ Addresses:_________________________________________________ ___________________________________________________________ ___________________________________________________________
1. Other factors.
Describe or list here any facts or matters that do not seem to be covered by the other sections of this questionnaire and that you believe may be important for your estate planning attorney to know.
2. Community property.
If you now live in or have lived in one of the states listed below, or if you own real estate in one of these states, please circle the name of the state and indicate whether you and your spouse have entered into any agreement about whether that property is separate property. States: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, Wisconsin
3. Powers of attorney. Have you given a power of attorney to your spouse, a child, or any other person authorizing them to do either specific things on your behalf or to act generally on your behalf? If so, please indicate to whom it was given, the nature of the power (specific or general), the date, and the location of the document granting the power.
Tip: See sample durable power of attorney.
4. Living will.
Have you signed any document indicating your wishes concerning the "heroic" or extraordinary measures to save your life in the event of a catastrophic illness or injury? If not, would you like to do so?
5. Health care power.
Have you signed any document specifically authorizing another person such as your spouse to make decisions with respect to your health care in the event that you are unable to do so? If not, would you like to do so?
Tip: See sample durable power of attorney for health care.
Security codes and passwords: This is another huge one. Your family members will not be able to access your account information if they do not have your log in information and passwords. In our web based society, passwords are often the key to your family being able to efficiently access the information they need. Also spare keys and any other security measures should be disclosed in writing and kept in a safe place for your family members use down the road.
Easy access to your will and durable powers of attorney: Keep a copy at your attorney’s office, one in a fireproof safe at your home and third copy should be given to the executor of your estate.
Date this form was last updated: