Estate Planning Questionnaire

Part 1: Personal Information

Client's Legal Name

(name most often used to title property and accounts)

First Middle Last Suffix

Also Known As

(other names used to title property and accounts)

First Middle Last Suffix

Prefer to be called

Birth Date

Are you a U.S. citizen?

Yes

No

Home Address

Street Address Address Line 2 City State ZIP Code

County of Residence

Primary Phone

Secondary Phone

Employer

Position

Business Address

Street Address Address Line 2 City State ZIP Code

Email

Is it okay to communicate with you via email?

Yes

No

Date of Marriage

Client's Spouse or Second Grantor's Legal Name

(name most often used to title property and accounts)

First Middle Last Suffix

Also Known As

(other names used to title property and accounts)

First Middle Last Suffix

Prefer to be Called

Birth Date

Is spouse/second grantor a U.S. citizen?

Yes

No

Home Address

Street Address Address Line 2 City State ZIP Code

County of Residence

Primary Phone

Secondary Phone

Employer

Position

Business Address

Street Address Address Line 2 City State ZIP Code

Email

Is it okay to communicate with you via email?

Yes

No

Children & Other Family Members

Use full legal name.

How many children do you have?

Name of Child 1

First Middle Last Suffix

Child 1 Birth Date

Child 1 Parent or Relationship

Child 1 Address

Street Address Address Line 2 City State ZIP Code

Child 1 Additional Comments

Name of Child 2

First Middle Last Suffix

Child 2 Birth Date

Child 2 Parent or Relationship

Child 2 Address

Street Address Address Line 2 City State ZIP Code

Child 2 Additional Comments

Name of Child 3

First Middle Last Suffix

Child 3 Birth Date

Child 3 Parent or Relationship

Child 3 Address

Street Address Address Line 2 City State ZIP Code

Child 3 Additional Comments

Name of Child 4

First Middle Last Suffix

Child 4 Birth Date

Child 4 Parent or Relationship

Child 4 Address

Street Address Address Line 2 City State ZIP Code

Child 4 Additional Comments

Name of Child 5

First Middle Last Suffix

Child 5 Birth Date

Child 5 Parent or Relationship

Child 5 Address

Street Address Address Line 2 City State ZIP Code

Child 5 Additional Comments

Advisors

Personal Attorney Name

First Last

Phone

Accountant Name

First Last

Phone

Financial Advisor Name

First Last

Phone

Life Insurance Agent

First Last

Phone

Client's Concerns

Please rate the following as how important they are to you/the client.

Desire to get affairs in order & create a comprehensive plan to manage affairs in case of death or disability.

Providing for and protecting a spouse.

Providing for and protecting children.

Providing for and protecting grandchildren.

Disinheriting a family member.

Providing for charities at the time of death.

Plan for the transfer and survival of a family business.

Avoiding or reducing your estate taxes.

Avoiding probate.

Reduce administration costs at time of your death.

Avoiding a conservatorship ("living probate") in case of a disability.

Avoiding will contests or other disputes upon death.

Protecting assets from lawsuits or creditors.

Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.

Plan for a child with disabilities or special needs, such as medical or learning disabilities.

Protecting children's inheritance from the possibility of failed marriages.

Protecting children's inheritance in the event of a surviving spouse's marriage.

Provide that your death shall not be unneccessarily prolonged by artificial means or measures.

List any additional concerns below.

Spouse's Concerns

Please rate the following as how important they are to your spouse.

Desire to get affairs in order & create a comprehensive plan to manage affairs in case of death or disability.

Providing for and protecting a spouse.

Providing for and protecting children.

Providing for and protecting grandchildren.

Disinheriting a family member.

Providing for charities at the time of death.

Plan for the transfer and survival of a family business.

Avoiding or reducing your estate taxes.

Avoiding probate.

Reduce administration costs at time of your death.

Avoiding a conservatorship ("living probate") in case of a disability.

Avoiding will contests or other disputes upon death.

Protecting assets from lawsuits or creditors.

Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.

Plan for a child with disabilities or special needs, such as medical or learning disabilities.

Protecting children's inheritance from the possibility of failed marriages.

Protecting children's inheritance in the event of a surviving spouse's marriage.

Provide that your death shall not be unneccessarily prolonged by artificial means or measures.

List any additional concerns below.

Part II: Property Information

This checklist helps you list all the property you own and what it's worth. How you own your property is extremely important for purposes of properly designing and implementing your estate plan.

FOR EACH PROPERTY: Please indicate how the property is titled in the "Owner" field using the following abbreviations:
C - if married, client's name alone, with no other person
S - if married, spouse's name alone, with no other person
JTS - if married, joint tenancy with spouse
JTO - joint tenancy with someone other than a spouse, i.e. a child, parent, etc.
? - if you cannot determine how the property is owned

Real Property

TYPE: Any interest in real estate including your family residence, vacation home, timeshare, vacant land, etc.
Use the "+" sign to add as many rows as needed.

General Description and/or Address

Owner

Market Value

Loan Balance

CLIENT'S Real Property Total Market Value $

CLIENT'S Real Property Total Loan Balance $

SPOUSE'S Real Property Total Market Value $

SPOUSE'S Real Property Total Loan Balance $

TOTAL Real Property Market Value $

TOTAL Real Property Loan Balance $

Furniture & Personal Effects

TYPE: List separately any major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (indicate type below and also give a lump sum value for miscellaneous, less valuable items).
Use the "+" sign to add as many rows as needed.

Type or Description

Owner

Market Value

CLIENT'S Furniture & Personal Effects Market Value $

SPOUSE'S Furniture & Personal Effects Market Value $

TOTAL Furniture & Personal Effects Market Value $

Automobiles, Boats, and RVs

Use the "+" sign to add as many rows as needed.

Type or Description

Owner

Market Value

Encumbrance

CLIENT'S Automobiles, Boats, & RVs Market Value $

CLIENT'S Automobiles, Boats, & RVs Encumbrance $

SPOUSE'S Automobiles, Boats, & RVs Market Value $

SPOUSE'S Automobiles, Boats, & RVs Encumbrance $

TOTAL Automobiles, Boats, & RVs Market Value $

TOTAL Automobiles, Boats, & RVs Encumbrance $

Bank Accounts

Please use these abbreviations for types of accounts:
CA - Checking Account
SA - Savings Account
CD - Certificates of Deposit
MM - Money Market
(DO NOT include IRAs or 401(k)s here.)
If account is in your name (or your spouse's name) for the benefit of a minor, please specify and give the minor's name in the type of account field.
Use the "+" sign to add as many rows as needed.

Name of Institution

Account Number

Type of Account

Owner

Amount

CLIENT'S Total Amount for Bank Accounts $

SPOUSE'S Total Amount for Bank Accounts $

TOTAL Amount for Bank Accounts $

Stocks and Bonds

List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account.
Use the "+" sign to add as many rows as needed.

Stocks, Bonds or Investment Accounts

Type of Account

Account Number

Owner

Amount

CLIENT'S Total Amount for Stocks & Bonds $

SPOUSE'S Total Amount for Stocks & Bonds $

TOTAL Amount for Stocks & Bonds $

Life Insurance Policies & Annuities

TYPES:
Term
Whole life
Split dollar
Group life
Annuity
Use the "+" sign to add as many rows as needed.

Insurance Company

Type

Face Amount (Death Benefit)

Whose Life is Insured

Who Owns Policy

Who Pays Premium

Agent Name

CLIENT'S Amount for Life Insurance Policies & Annuities $

SPOUSE'S Amount for Life Insurance Policies & Annuities $

TOTAL Amount for Life Insurance Policies & Annuities $

Retirement Plans

Please use these abbreviations for types of accounts:
P - Pension
PS - Profit Sharing
H.R. 10
IRA
SEP
401(K)
Use the "+" sign to add as many rows as needed.

Type of Plan

Plan Name

Current value of plan

Other pertinent info

CLIENT'S Amount for Retirement Plans $

SPOUSE'S Amount for Retirement Plans $

TOTAL Amount for Retirement Plans $

Business Interests

Types:
General and Limited Partnerships
Sole Proprietorships
Privately-owned corporations
Professional corporations
Oil interests
Farm interests
Ranch interests
Use the "+" sign to add as many rows as needed.

Type of Interest

Description

Who has the interest

Your ownership

Estimated Value

CLIENT'S Amount for Business Interests $

SPOUSE'S Amount for Business Interests $

TOTAL Amount for Business Interests $

Money Owed To You

Types: Mortages or promissor notes payable to you, or other moneys owed to you.
Use the "+" sign to add as many rows as needed.

Name of Debtor

Date of Note

Maturity Date

Owed to

Current Balance

CLIENT'S Amount Money Owed to You $

SPOUSE'S Amount Money Owed to You $

TOTAL Amount Money Owed to You $

Anticipated Inheritance, Gift, or Lawsuit Judgment

TYPE: Gifts or inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

CLIENT'S Total Anticipated Inheritance, Etc.

SPOUSE'S Total Anticipated Inheritance, Etc.

GRAND TOTAL Anticipated Inheritance, Etc.

Other Assets

Types: Other property is any property that you have that does not fit into any listed category.
Use the "+" sign to add as many rows as needed.

Type

Owner

Value

CLIENT'S Total Other Assets $

SPOUSE'S Total Other Assets $

TOTAL Other Assets $

Summary of Values

Grand Total for Client

Grand Total for Spouse

Grand Total for Both

Consent

Signature of Client or Client Representative

Date

Signature of Client or Client Representative

Date

SAVANNAH

STATESBORO

Atlanta

Part 1: Personal Information

Children & Other Family Members

Advisors

Client's Concerns

Spouse's Concerns

Important Family Questions

Part II: Property Information

Summary of Values

Part 3: Design Information

Persons to Act For You

Distributions of Personal Property and Specific Gifts

Providing for the Surviving Spouse Upon Death of First Spouse to Die

Who is responsible for determining lifetime distributions?

Limited Power of Appointment

Division of Property Upon Death of Second Spouse to Die

How and When to Distribute My Property

Remote Contingent Beneficiary

Consent

CALL US TO GET STARTED

Consultation

Implementation

SAVANNAH

STATESBORO

Atlanta

PRACTICE AREAS