Estate Planning Organizer

YOUR INFORMATION IS CONFIDENTIAL

ESTATE PLANNING QUESTIONAIRE

** If any fields do not apply to you please use "n/a" to indicate not applicable. **

** If you do not have the info requested at this time please put "needed". **

PRIOR MARRIAGE(S)

Client 1

Name of Former Spouse:

Date and Place of Prior Marriage:

If marriage ended by divorce, list date and location of judgement papers:

If marriage ended by death, list date and location of death certificate:

Client 2

Name of Former Spouse:

Date and Place of Prior Marriage:

If marriage ended by divorce, list date and location of judgement papers:

If marriage ended by death, list date and location of death certificate:

CHILDREN AND OTHER RELATIVES

Living Children and Grandchildren

Please note that children of your present marriage are listed first. Children of prior marriage(s), whether of yourself or your spouse, are listed separately. In all cases, please provide the following information:

1. If the child is not living with you, the child's address.

2. If the child is married, list the name of the child's spouse and the names of their children, if any.

3. If you have children from a prior marriage, indicate with whom the child resides if not with you.

4. If any of your children are adopted, list the date of adoption and the location of documents.

5. If any child has special needs because of developmental, physical or mental disability, please indicate here, and separately list information regarding doctors, guardians and other pertinent data.

Children of Existing Marriage:

Child 1

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Child 2

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Child 3

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Child 4

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Children of Prior Marriage(s):

Client 1

Child 1

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Child 2

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Client 2

Child 1

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

Child 2

Full Name:

Address:

Date of Birth:

Gender:
MaleFemale

Name of spouse (if any):

Name of children (if any):

Other information requested above (if any):

DECEASED CHILDREN

Client 1

Child's Full Name:

Date of death:

Spouse's Name:

Address:

Any living issue of this child?
YesNo

A. Name of grandchild:

B. Date of birth:

Client 2

Child's Full Name:

Date of death:

Spouse's Name:

Address:

Any living issue of this child?
YesNo

A. Name of grandchild:

B. Date of birth:

PEOPLE RAISED BY CLIENT(S)

Are there people you and/or your spouse have raised as children who are not legally your children? (Note: An adopted child is legally your child) If so, please list.

1.

Full Name:

Address:

Any living issue of this child?
YesNo

Date of Birth:

Legal relationship:

For purposes of your Will and/or Trust, do you wish this person to be considered your child?
YesNo

2.

Full Name:

Address:

Any living issue of this child?
YesNo

Date of Birth:

Legal relationship:

For purposes of your Will and/or Trust, do you wish this person to be considered your child?
YesNo

OTHER FAMILY MEMBERS

List other members of your family who are closest in relationship to you (i.e., parents, siblings). If any are dependent upon you for support, please specify. If you have friends that you consider as close as family members, please include them here.

Client 1

1.

Name and Address:

Relationship:

Date of Birth:

Other information:

2.

Name and Address:

Relationship:

Date of Birth:

Other information:

3.

Name and Address:

Relationship:

Date of Birth:

Other information:

Client 2

1.

Name and Address:

Relationship:

Date of Birth:

Other information:

2.

Name and Address:

Relationship:

Date of Birth:

Other information:

3.

Name and Address:

Relationship:

Date of Birth:

Other information:

YOUR INFORMATION IS CONFIDENTIAL

ESTATE PLANNING QUESTIONAIRE

** If any fields do not apply to you please use "n/a" to indicate not applicable. **

** If you do not have the info requested at this time please put "needed". **

INFORMATION REGARDING IMPORTANT DOCUMENTS

The documents listed below are very important and are often needed when you are not available or not able to tell others where to find them. If you have executed any of the following documents, please provide me with a copy or its current location. If you don't know, take time now to find it or give enough information about if so someone else can find it when needed. If the document does not apply to you, put "n/a" next to it.

ESTATE PLANNING DOCUMENTS

Do you have a Will

YesNo

If "yes" please provide me with a copy.

Location:

Do you have a Trust

YesNo

If "yes" please provide me with a copy.

Location:

Durable Power of Attorney for Asset Management

YesNo

If "yes" please provide me with a copy.

Location:

Power of Attorney for Health Care (Advance Directive), Directive to Physician and/or Living Will

YesNo

If "yes" please provide me with a copy.

If any powers of attorney have been granted by you to another:

Date:

Holder of power:

State where executed:

Special powers granted or withheld:

Location of original(s):

Number of originals executed:

OTHER DEATH-RELATED DOCUMENTS

Funeral and Burial Arrangements:

Cemetery Plot and Deed to Plot:

Organ Donation Direction:

PERSONAL DOCUMENTS

Birth Certificate:

Marriage Certificate:

Divorce Decree:

Premarital Agreements (please provide me with copies):

Community Property Agreement(s) (please provide me with copies):

Marital Property Agreements (please provide me with copies):

Naturalization or Citizenship Documents:

Passport:

Your Children's Birth Certificates:

Your Children's Adoption Papers:

Military Service Records (Discharge Papers):

Employment Records:

TAX RETURNS

Copies of Income Tax Returns:

Copies of Gift Tax Returns:

ASSET AND LIABILITY RELATED DOCUMENTS

Brokerage Statements:

Stock Certificates and Bonds (Not held in a Brokerage Account):

Deed to Residence and/or Vacation Home:

Lease to Residence:

Credit Card Information List (Issuers and Account Numbers):

INSURANCE POLICIES

Life Insurance Policies:

Property Insurance Policies:

Disability Insurance Policies:

DISTRIBUTION OF YOUR ESTATE

Executors

In order of preference, please list the full names, relationships and addresses of your Executors:

Your Spouse First:

YesNo

1.

Name:

Relationship:

Address:

2.

Name:

Relationship:

Address:

Trustees

In order of preference, please list the full names, relationships and addresses of your Trustees:

Same as above?

YesNo

If not same as above:

1.

Name:

Relationship:

Address:

2.

Name:

Relationship:

Address:

Guardians of Minor Children:

In order of preference, please list the full names, relationships and addresses of guardians of any minor children.

1.

Name:

Relationship:

Address:

2.

Name:

Relationship:

Address:

3.

Name:

Relationship:

Address:

DURABLE POWER OF ATTORNEY, ASSET MANAGEMENT

In order of preference, please list the full names, relationships and addresses of your agents for your general durable powers of attorney (asset management if you are incapacitated)

Same as Executors?
YesNo

If no, spouse first?
YesNo

If neither of the above or as alternates:

1.

Name:

Relationship:

Address:

2.

Name:

Relationship:

Address:

3.

Name:

Relationship:

Address:

4.

Name:

Relationship:

Address:

DURABLE POWER OF ATTORNEY, HEALTH CARE

In order of preference, please list the full names, relationships and addresses of your agents for your general durable powers of attorney (asset management if you are incapacitated)

Same as Executors?
YesNo

If no, spouse first?
YesNo

If neither of the above or as alternates:

1.

Name:

Relationship:

Address:

2.

Name:

Relationship:

Address:

3.

Name:

Relationship:

Address:

4.

Name:

Relationship:

Address:

Health/Special Needs

Do either you or your spouse have any special health concerns?
YesNo

If "yes", please explain:

Do any of your children have special needs you would like to address in your estate plan?
YesNo

If "yes", please explain:

Disinheritance

Do you wish to specifically disinherit an individual or group of people?
YesNo

If "yes", please list their full names, relationship to you, and addresses. You may provide a brief explanation if you like:

1.

Name:

Relationship:

Address:

Explanation:

2.

Name:

Relationship:

Address:

Explanation:

3.

Name:

Relationship:

Address:

Explanation:

Distribution of Property on Death

In General:

What is your desired disposition of your property on your death and/or your spouse's death?

If Married:

All to your spouse on your death?
YesNo

To your children in equal shares on your spouse's death?
YesNo

If Not Married:

To your children in equal shares on your spouse's death?
YesNo

If neither of the above, to whom do you wish to leave your property, and in what proportions? Please list full names and addresses.

1.

Name:

Relationship:

Proportion:

2.

Name:

Relationship:

Proportion:

3.

Name:

Relationship:

Proportion:

CHILDREN'S AGES AND SHARES FOR DISTRIBUTIONS

When should your children receive their distributions?

Outright on your death:
YesNo

Outright on your spouse's death:
YesNo

If not outright, please provide age(s) of distribution and the fractional or percentage of interest of each child's share to be distributed at specified age(s):

EXAMPLE:

Name of Child:	Jane Alexandra Smith
Age:	Fractional or % Interest of Share
Age 21:	1/4 of share
Age 24:	1/2 of share
Age 30:	Remainder of Share

Child 1.

Name of Child:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Child 2.

Name of Child:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Child 3.

Name of Child:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Child 4.

Name of Child:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

Age/Fractional or % Interest of Share:

If a child or children of yours predecease you would you like their issue (your grandchildren) to receive their distribution?
YesNo

If yes, at the same ages listed above?
YesNo

Simultaneous Death

Desired disposition of estate in the event you, your spouse and your issue die simultaneously:

EXAMPLES:

1. Your heirs (determined by California Law)

2. Specific named individuals (other than your heirs generally)

3. A specific charity (Red Cross, Boy's Town, Girl Scouts)

1.

2.

3.

Specific Bequests

List specific bequests you wish to make, if any, indicating what and to whom. In the event the individual or organization does not survive, please specify if the gift will be distributed to that individual's issue, to someone else, or if the gift will lapse and become part of the residue of your estate, as in the following examples:

1. Diamond and ruby cocktail to John Doe, my friend, 1234 Easy Street, Avocado, California. If John Doe is not living, to his issue by right of representation.

2. Ermine stole, Hobie catamaran, and the sum of $ 5,000 to Jane Roe, my sister-in-law, 4321 Memory Lane, Hometown, Ohio. If Jane Roe is not living, to Mary Doe, my friend, 1234 Easy Street, Avocado, California.

3. Antique sheet music collection and 1 harpsichord to Best School of Music Scholarship fund, 51 Crescendo Lane, Solotown, Pennsylvania. If this scholarship fund is not in existence at my death, this gift shall lapse.

4. The sum of $ 1,000 to Boy Scouts of America, c/o National Headquarters, 321 Right Path, Eagletown, New York, or to its successor. If Boy Scouts of America or its successor is not an organization at the time of my death, this gift shall lapse.

1.

2.

3.

4.

5.

YOUR INFORMATION IS CONFIDENTIAL

ESTATE PLANNING QUESTIONAIRE

** If any fields do not apply to you please use "n/a" to indicate not applicable. **

** If you do not have the info requested at this time please put "needed". **

KEY ADVISORS

Lawyer

Name and Address:

Telephone Number:

Fax Number:

If listing this office:

Who referred you to this office?

Name, Address and Phone Number:

Relationship to you or to office staff:

Other Lawyer

Name and Address:

Telephone Number:

Fax Number:

Accountant

Name and Address:

Telephone Number:

Fax Number:

STOCKBROKERS/INVESTMENT ADVISORS

Stockbroker 1.

Name and Address:

Institution:

Telephone Number:

Fax Number:

Email Address:

Stockbroker 2.

Name and Address:

Institution:

Telephone Number:

Fax Number:

Email Address:

INSURANCE AGENTS:

Insurance Agent 1.

Name and Address:

Company:

Telephone Number:

Fax Number:

Email Address:

Type of insurance coverage:

Insurance Agent 2.

Name and Address:

Company:

Telephone Number:

Fax Number:

Email Address:

Type of insurance coverage:

Trust Officer (Primary Banker):

Name and Address of Institution:

Name of contact person:

Telephone Number:

Fax Number:

Email Address:

Account Number:

Pension Plan Administrator:

Name and Address of Plan:

Name of contact person:

Telephone Number:

Fax Number:

Email Address:

Account Number(s):

Doctor:

Name and Address:

Telephone Number:

SAFETY DEPOSIT BOXES

Safety Deposit Box 1.

Name and Address of Bank:

Full name(s) of person(s) entitled to access:

Safety Deposit Box 2.

Name and Address of Bank:

Full name(s) of person(s) entitled to access:

Safety Deposit Box 3.

Name and Address of Bank:

Full name(s) of person(s) entitled to access: