Estate Planning Questionnaire for Individuals

Step 1 of 7

STEP 5

APPOINTMENTS – PEOPLE TO ASSIST YOU

One of the most important aspects of any estate plan is the “appointment” of various persons to assist you and your family in times of need – particularly when death or disability strikes. These appointed “helpers” are called by different names depending on the role they play in protecting your family and your estate.

Successor Decision Makers for Financial and Health Care Matter

If you were mentally incapacitated for any period of time, who would you choose to handle your financial affairs? This person would be authorized to make financial decisions for you. Note that only one agent can serve at a time. * Please add address and phone number if not already provided.

Financial Decision Makers

First Choice (Required)

Full Legal Name(Required)

Address(Required)

Phone(Required)

Date of Marriage

Social Security Number(Required)

Last Account Number (4 Digits)(Required)

Second Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Third Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Healthcare Decision Makers

If you were mentally incapacitated for any period of time, who would you choose to make healthcare decisions for you? An agent with medical power of attorney is a person authorized to make medical and healthcare decisions for you. Note that only one agent can serve at a time. *Please add address and telephone number if not already provided.

First Choice (Required)

Full Legal Name(Required)

Address(Required)

Phone(Required)

Date of Marriage

Social Security Number(Required)

Last Account Number (4 Digits)(Required)

Second Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Third Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Guardian of Minor or Adult Disabled Child(ren)

Who would you like to serve as Guardian for your minor or adult disabled children (if any) in the event you and your spouse die? A guardian is a court approved individual who makes decisions regarding a minor child’s support, care, education, health, and welfare. A guardian will have physical custody of your child(ren).

First Choice (Required)

Full Legal Name(Required)

Address(Required)

Phone(Required)

Date of Marriage

Social Security Number(Required)

Last Account Number (4 Digits)(Required)

Second Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Third Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Executor of Estate

Who would you like to serve as Executor or Representative of your estate? An executor or representative has broad powers to administer and distribute your property after death. Spouses typically name each other as the executor and then other family members as the successors (triggered only if the named executor or representative is deceased or otherwise unavailable).

First Choice (Required)

Full Legal Name(Required)

Address(Required)

Phone(Required)

Date of Marriage

Social Security Number(Required)

Last Account Number (4 Digits)(Required)

Second Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Third Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Trustee

If applicable, who would you like to serve as Trustee? A trustee is a person or entity who administers and distributes property held in a trust. A trust may be established under your will or outside of your will for a variety of purposes such as for the purpose of administering property that would otherwise pass outright to minor children.

First Choice (Required)

Full Legal Name(Required)

Address(Required)

Phone(Required)

Date of Marriage

Social Security Number(Required)

Last Account Number (4 Digits)(Required)

Second Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

Third Choice

Full Legal Name

Address

Phone

Date of Marriage

Social Security Number

Last Account Number (4 Digits)

STEP 6

ASSET ASSESSMENT

Determining the ownership, value and character of your assets is important to your estate and legacy plan. The title “ownership” is important for tax and transfer matters. The “value” will be significant in determining potential tax liability. The “character” is relevant in assessing the manner in which the assets can transfer.

Asset Information

The financial values listed are for discussion purposes only. A more accurate list will be obtained at a later date. To identify the owner of an asset, use “JTS” for joint ownership with spouse or partner; “JTO” for joint ownership with nonspouse. If married use “H” to indicate Husband as sole owner; “W” to indicate the Wife as sole owner. If in a civil union or partnership, use “Client 1” or “Client 2” to indicate ownership. Use “T” if owned by a revocable trust that you have created.

Bank and Savings Accounts

To identify type of account, use “CA” for checking account; “SA” for savings account; “CD” for certificate of deposit; and “MM” for money market account. Do not include any kind of retirement accounts here.

Bank and Savings Accounts:

Savings Accounts, Checking Accounts, Money Market Accounts, and CDs

Owner

Market Value

Type of Account

Account # (last 4 numbers)

Retirement Accounts

These can include 401(k) plans, 403(B) plans, IRAs, Keoghs, Profit Sharing Plans, Pension Plans, and PERA.

Retirement Accounts:

Retirement Accounts (IRA, 401(k), Roth, or Tax-Qualified Annuities, etc.)

Owner

Market Value

Type of Account

Account # (last 4 numbers)

Advisor Name, if any

Stocks, Bonds, or Investment Accounts

List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. Do not include IRAs, 401(k)s, or other retirement plan assets.

Stocks, Bonds, or Investment Accounts:

Stocks, Bonds, Mutual Funds, Other Investment Accounts

Owner

Market Value

Account # (last 4 numbers)

Advisor Name, if any

Life Insurance Policies and Annuities

List the issuing company. To identify type of contract, use “T” for terminsurance, “CV” for insurance policies having a cash value, “A” for annuities.

Life Insurance Policies and Annuities:

Insurance Company and Policy Number

Type

Owner

Insured

Cash Value

Death Benefit

Advisor Name, if any

Business Interests

List family businesses, closely held corporations, privately held businesses, partnerships or LLCs, and any ownership percentage you own in them.

Business Interests:

Business Entity

Owner

Type (LLC, LLP, Corp, Sole Prop)

Ownership %

Value

Real Estate Holdings

This includes your primary residence, secondary residence, rental or investment properties, timeshares, farmland, oil and gas interest, mineral interest, water rights, etc. Make sure to include any real property owned in another state.

Real Estate Holdings:

Real Estate

Owner

Type (Homestead, Vacation, Rental)

Ownership %

Value

Intellectual Property

List any copyrights, patents, or trademarks here.

Intellectual Property:

Intellectual Property: Description

Owner

Other Personal Property

List other property that you have that does not fit into any other listed category. This may include household possessions, antiques, artwork, jewelry, collections, motor vehicles, boats, RVs, trailers, ATVs, aircraft, jet skis, snowmobiles, motorcycles, firearms, etc. If you have a beneficial interest in a trust created by another person (e.g. a parent or grandparent), list here.

Other Personal Property:

Other: Description

Owner

Market Value

SIMPLE BACKGROUND INFORMATION

Client Information

CHILDREN, GRANDCHILDREN, AND OTHER POTENTIAL “INDIVIDUAL” BENEFICIARIES INFORMATION

POTENTIAL “CHARITABLE” BENEFICIARIES

ADDITIONAL COMMENTS, GOALS, OR CONCERNS

APPOINTMENTS – PEOPLE TO ASSIST YOU

Successor Decision Makers for Financial and Health Care Matter

Financial Decision Makers

First Choice (Required)

Second Choice

Third Choice

Healthcare Decision Makers

First Choice (Required)

Second Choice

Third Choice

Guardian of Minor or Adult Disabled Child(ren)

First Choice (Required)

Second Choice

Third Choice

Executor of Estate

First Choice (Required)

Second Choice

Third Choice

Trustee

First Choice (Required)

Second Choice

Third Choice

ASSET ASSESSMENT

Asset Information

Bank and Savings Accounts

Retirement Accounts

Stocks, Bonds, or Investment Accounts

Life Insurance Policies and Annuities

Business Interests

Real Estate Holdings

Intellectual Property

Other Personal Property

LIABILITIES