ESTATE PLANNING QUESTIONNAIRE
BACKGROUND INFORMATION
Married: Y: _______________ N: ___________________
Spouses Name:
Name of Children:
Who do you want to be the guardian of the person of any minor children?
Who do you want to be the guardian of the estate (financial matters) of any minor children?
Who do you want to be the executor (the person who administers your will and carries out your wishes) of your will (if other than your current spouse, or as a back up if your spouse predeceases you, or cannot serve as executor)?
Who do you want to be the trustee (the person who administers your trust and carries out your wishes) of your trust if both you and your spouse [if applicable] have died?
Do you currently have an existing will and/or trust?
Y: ____________ N:______________
Do you currently have a life insurance policy?
Y:____________ N:______________
How do you wish to distribute your assets and to whom?
Do you wish to omit any beneficiary that would ordinarily be considered as an heir?
Do you wish to make any specific or special gifts and, if so to whom?
Do you wish to make any charitable gifts, and if so, to what organization(s)?
Do you have any special circumstances or issues that should be dealt with via estate plan?
Do you have any concerns or special circumstances regarding the estate tax threshold?
HEALTH AND MEDICAL
Person(s) who I wish to make decisions for me if I am unable to do so:
Name of Health Insurance and Policy Information:
My Primary Care Physician:
Other Physicians Who Should be Notified in Case of Emergency:
Have You Previously Executed a Medical Directive?
Y:_________________ N:_________________
ASSET INFORMATION
Please use this guide as a method of keeping track of your major assets so they can be located in the event necessary.
Real Estate:
Property 1
Address:
How is Legal Title Held?
Name(s) of Mortgage Holder(s):
Property 2
Address:
How is Legal Title Held?
Name(s) of Mortgage Holder(s):
Property 3
Address:
How is Legal Title Held?
Name(s) of Mortgage Holder(s):
Property 4
Address:
How is Legal Title Held?
Name(s) of Mortgage Holder(s):
Interests in Corporations, Partnerships and/or Limited Liability Companies:
Entity 1:
Name of Entity:
Amount of Stock or Equity Owned:
Entity 2:
Name of Entity:
Amount of Stock or Equity Owned:
Entity 3:
Name of Entity:
Amount of Stock or Equity Owned:
Stock or Investment Accounts:
Account 1:
Company:
Account or Brokerage Number:
Broker or Contact Information:
Account 2:
Company:
Account or Brokerage Number:
Broker or Contact Information:
Bank Accounts:
Account 1:
Branch and Address:
Account Number:
Safe Deposit Box Y: ____________ N:____________
Account 2:
Branch and Address:
Account Number:
Safe Deposit Box Y:____________ N:____________
Automobiles and Other Vehicles
Vehicle 1:
Make, Model, Year and Color:
How is Title Held?
Vehicle 2:
Make, Model, Year and Color:
How is Title Held?
Vehicle 3:
Make, Model, Year and Color:
How is Title Held?
Vehicle 4:
Make, Model, Year and Color:
How is Title Held?
Art, Jewelry or Other Valuable Personal Property:
Items:
1.
2.
3.
4.
5.
6.
7.
8.
Credit Cards:
Card Issuer and Account Number:
Card Issuer and Account Number:
Card Issuer and Account Number:
Card Issuer and Account Number:
Card Issuer and Account Number:
My Valuable Papers can be Found:
(use this to let relatives know where important papers are stored so they may be located):
Other Important Things My Relatives Should Know: