Estate Planning

Following is a data collection form we use to prepare estate planning documents.

ESTATE PLANNING WORKSHEET

 

PLEASE FILL OUT THE FOLLOWING INFORMATION TO THE BEST OF YOUR ABILITIES, PAYING SPECIAL ATTENTION TO SPELLING OF NAMES

 

I. Personal information

 

Husband Name:____________________________

Wife Name:________________________________

Address:      ________________________________

                       ________________________________

Husband Date of Birth:____________

Husband SS No.:_________________

Wife Date of Birth:_______________

Wife SS No.:_____________________


II. Beneficiaries

Do you want everything to go to the surviving spouse first?___________________________

 

Is this a first or subsequent marriage?________________________

 

Here, list other people you would like to receive a part of your estate, including family members, friends, and charities.

 

Children’s Names Address Date of Birth

1. __________________________ ___________________________ ______________

2. __________________________ ___________________________ ______________

3. __________________________ ___________________________ ______________

4. __________________________ ___________________________ ______________

 

Other Individuals:   (Include friends, grandchildren, brothers and sisters, or anyone else to whom you would like to give a part of your estate.)

 

Name

_____________________

_____________________

_____________________ Address

________________________

________________________

________________________ Relationship

____________

____________

____________ Date of Birth

____________

____________

____________

Charities: (List any religious or other non-profit organizations to whom you would like to make a bequest.  This may reduce the taxes on your estate.)

 

Charity

________________________________________

________________________________________Bequest

___________________________________

___________________________________

 

III. Executor and Successor Trustee

 

Name the person or persons you would like to appoint to administer your estate and/or Trust and their address and telephone number.  He or she -- in which case she is called the "executrix" -- will carry out your wishes as stated in your will.  Two people may serve together in this role.  Also name an alternate in case the first appointed cannot serve for any reason.

 

Executor, executrix Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________

 

IV.  Attorney-In-Fact

 

Name the person you would like to appoint to handle your business affairs in the event of your incapacity, and their address and telephone number.  He or she will act on your behalf should you be unable to handle your own affairs. 

 

Attorney-In-Fact Address/Phone

 

1. _______________________________ ________________________________

 

Name the person you would like to appoint to make medical decisions on your behalf should you be unable to, and their address and telephone number.  He or she will be responsible for making major medical decisions in accordance with your wishes as stated in your Advance Directive.  Also name an alternate in case the first appointed cannot serve for any reason.

 

Health Care Representative Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________ 

 

V. Lifetime Fiduciaries

 

Should you at any time in the future become incapacitated, it may be necessary for the Court to appoint a Guardian or Conservator to represent you.  Name the person you would like to appoint to serve as Guardian or Conservator, and their address and telephone number.  Also name an alternate in case the first appointed cannot serve for any reason.

 

Guardian Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________ 

 

 

Conservator Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________ 

 

VI. Guardian of Children

 

The most important purpose of a will for most younger people is the appointment of a guardian for their children under age 18.  All people with children should have wills for this purpose.  Again, two people may serve together in this role.  Also name an alternate in case the first appointed cannot serve for any reason

 

Guardian’s Name(s) Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________

 

You may wish for someone other than the Guardian to handle financial matters concerning your children.  That person would be named the Trustee of any Testamentary Trust created for their benefit.  Again, two people may serve together in this role.  Also name an alternate in case the first appointed cannot serve for any reason

 

Trustee’s Name(s) Address/Phone

 

1. _______________________________ ________________________________

2. _______________________________ ________________________________

 

VII. Your Estate

 

List the contents of your estate, including bank accounts, stock, IRAs, real estate, motor vehicles, life insurance, and anything else that you may own, whether by yourself or with another person.  For this purpose, an estimate of the value is sufficient.

 

Bank Accounts (financial institution and account numbers)

 

1. ______________________________________________ $______________

2. ______________________________________________ $______________

3. ______________________________________________ $______________

 

Real Estate

 

1. _____________________________________________ $______________

2. _____________________________________________ $______________

Stocks, Bonds, Treasury Notes, Other Investments

 

1. ______________________________________________ $______________

2. ______________________________________________ $______________

3. ______________________________________________ $______________

 

Life Insurance, IRAs, Pension, 401K

Death Benefit Cash Value

1. ____________________________ $_____________ $______________

2. ____________________________    $_____________ $______________

3. ____________________________    $_____________ $______________

 

Tangible Personal Property

 

(This category includes vehicles, furniture, jewelry or artwork -- anything of significant value or that you would like to go to a particular person.)

 

Item

 

____________________________

____________________________

____________________________

____________________________ 

____________________________ Value

 

______________

______________

______________

______________

______________ Gift to Whom

 

___________________________

___________________________

___________________________

___________________________

___________________________

VIII. Burial Instructions

 

Please state below any specific wishes you may have for your burial:

____________________________________________________________________________________

____________________________________________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

 

 

 

FOR OFFICE USE ONLY 

 

I. Durable POA ____   

 

II. Health Care POA ______   

 

III. Mental Health Care POA ______

 

IV. Nomination of Fiduciaries _______

 

V.  Will ____   

 

_____ Pourover _____ Simple, no residuary trust _____ With residuary trust

 

VI. Trust ____  

 

_____  Revocable _____ Tax Planning, A/B Trust _____  Irrevocable 

 

Schedule A to include:

 

_______ Real Property:___________________________________________________

_______ Personal Property:________________________________________________

_______ Other:_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

 

 

VII. Deed ____ _____     Bargain and Sale Deed _____     Bargain/Sale with Life Estate

 

Property Address: ____________________________________________________________

            ____________________________________________________________

Legal Description: Client provide deed?   ________ Order Cust Svc Report? _________

 

Grantor(s):       __________________________ Grantee(s):      ______________________________