ESTATE PLANNING WORKSHEET – INDIVIDUAL
Please complete this Worksheet to the best of your ability and bring it with you to our meeting.
Meeting Date: _______________________________
A. PERSONAL
1. Full Name:
__________________________________________
2. Other Names:
__________________________________________
3. Addresses:
a. Home:
__________________________________________
__________________________________________
b. Mailing:
__________________________________________
4. Telephone:
a. Home:
________________________________
b. Work/Cell:
________________________________
5. Email Address:
a. Home:
________________________________
b. Work:
________________________________
6. Occupation/
Business:
__________________________________________
7. Business
Address:
__________________________________________
__________________________________________
8. Date and Place of Birth:
________________________________
9. Social Security Number: ______________________________
10. Citizenship:
________________________________
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B.
ADVISORS (Attorneys, accountants/CPAs, financial planners, insurance agents, physicians)
1. Name:
__________________________________________
Address:
__________________________________________
__________________________________________
Phone/Email:
2. Name:
__________________________________________
__________________________________________
Address:
__________________________________________
__________________________________________
Phone/Email:
C.
NOTIFICATION (Please list anyone you wish to be notified of your death.)
1. Name:
________________________________
3. _____________________________
________________________________
_______________________________
________________________________
_______________________________
Phone/Email: ______________________________
_______________________________
Address:
2. Name:
________________________________
4. _____________________________
________________________________
_______________________________
________________________________
_______________________________
Phone/Email: ______________________________
_______________________________
Address:
D.
__________________________________________
PRIOR MARRIAGES (If applicable)
1. Former Spouse:
__________________________________________
2. Date of
Marriage:
__________________________________________
3. Ended by
Death/Divorce on: __________________________________________
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4. Obligations to or
from former spouse: ____________________________________________
5. Child Support:
E.
__________________________________________
CHILDREN (Include adopted and foster children. Please indicate if child of prior marriage.)
1.
Living Children.
a. Name:
__________________________________________
Age & DOB:_________________________________________
b. Name:
__________________________________________
Age & DOB:_________________________________________
c. Name:
__________________________________________
Age & DOB:_________________________________________
2. Deceased children. (Do you have any deceased children? If the deceased child has any surviving
children, please list the surviving grandchildren.)
______________________________________________________________________________
______________________________________________________________________________
F.
DEPENDENTS
Are there any persons (other than minor children) who are partially or wholly dependent upon you
for support now or possibly in the future (such as elderly parents)?
Yes
☐
No
☐
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G.
INTERSPOUSAL AGREEMENTS (If you were formerly married)
1. Have you ever executed a Community Property Agreement?
Yes
☐
No
☐
2. Have you ever executed any other agreements between spouses
regarding your property (such as a pre-nuptial agreement)?
☐
☐
Yes
☐
No
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3. Please bring any agreements to our meeting.
H.
TRUSTS
1. Does any member of your family receive income from any trust?
If yes, who created the trust? _____________________________________________________
2. Has husband or wife ever created a trust, except as part of a Will?
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☐
If yes, give details: _____________________________________________________________
_____________________________________________________________________________
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3. Are you the trustee of any trust?
☐
4. Please bring all instruments relating to the trusts to the meeting.
I.
INSURANCE
1. Are there any life insurance policies in existence on the life of either spouse?
2. If so, please provide information regarding:
a. Type of Insurance (Term or Cash Value): ______________________________________
__________________________________________________________________________
b. Amount and Cash Surrender Value: __________________________________________
__________________________________________________________________________
c. Designated Beneficiary(ies): ________________________________________________
__________________________________________________________________________
J.
RETIREMENT BENEFITS
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Is either spouse a participant in a retirement plan? If so, please provide information regarding type of
plan, current value, beneficiary designation, etc.
___________________________________________________________________________________
___________________________________________________________________________________
K.
___________________________________________________________________________________
GIFTS AND/OR INHERITANCES
Yes
No
1. Is husband or wife likely to receive any gifts or inheritances?
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☐
2. Does either husband or wife make, or intend to make, regular gifts to any person? ☐
☐
If yes, please describe: __________________________________________________________
______________________________________________________________________________
L.
JOINT TENANCY ASSETS
Do you own any real or personal property as joint tenants with each other or third parties?
If so, please describe: ______________________________________________________________
________________________________________________________________________________
M.
ASSET SCHEDULE (Please indicate if any asset is separate property of either husband or wife and
approximate value)
1. Real Property:
$ _________________________
2. Stocks and Bonds:
$ _________________________
3. Checking/Savings:
$ _________________________
4. Safe Deposit Box Contents:
$ _________________________
5. Life Insurance:
$ _________________________
6. Digital Assets:
(books, photos, movies, eBay)
$ _________________________
7. Miscellaneous Property:
$ _________________________
(furniture, antiques, automobiles)
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8. Retirement Programs:
$ _________________________
Subtotal:
$ _________________________
9. LESS Liabilities (listed below)
($ _________________________)
10. Net Worth (Approximate)
N.
O.
$ _________________________
DEBTS AND LIABILITIES
1. Accounts Payable:
$ _________________________
$ _________________________
2. Credit Cards:
$ _________________________
$ _________________________
3. Home Mortgage:
$ _________________________
$ _________________________
4. Other:
$ _________________________
$ _________________________
PLANNING OBJECTIVES AND PRIORITIES
Please describe any significant planning objectives or priorities you may have.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
P.
TENTATIVE WILL PROVISIONS TO BE DISCUSSED WITH ATTORNEY
1. Personal Representative(s) (Administers Will during Probate)
1st Choice: __________________________________________
2nd Choice: __________________________________________
2. Trustee(s) (For Wills with trusts only)
1st Choice: __________________________________________
2nd Choice: __________________________________________
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3. Guardian(s) of Minor(s) (Guardian raises children who are not yet age 18)
1st Choice (Name & Relationship): ____________________________________
2nd Choice (Name & Relationship): ____________________________________
4. Distribution of Trust Estate (For Wills with trusts only)
a. Age of youngest child
before Distribution:
_______________________________________
b. Age for Distribution
_______________________________________
(1) First portion:
_______________________________________
(2) Second portion:
_______________________________________
(3) Third portion:
_______________________________________
5. Specific Bequests to Individuals in Will (example: $10,000 to American Red Cross)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
6. Funeral/Burial Arrangements
(It is recommended that this provision not be included in the Will as the contents of the Will may
not be known at the time the funeral arrangements are being made. Specific wishes may instead
be made known to the persons who would be in charge of your estate at the time of your death.
However, if you prefer, it can be included in the Will.)
________________________________________________________________________________
________________________________________________________________________________
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7. Other specific provisions or information to be included in Will, such as operation or provision for
family business, disposition of a real property interest in another state, etc.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
8. Special provisions for the care of any pets
________________________________________________________________________________
Q.
________________________________________________________________________________
DURABLE POWER OF ATTORNEY
(The Durable Power of Attorney is a document which is either effective upon signing or can become
effective upon the proven incompetency of an individual to handle his or her own affairs. The value
of this document is that it would hopefully avoid the necessity of a guardianship in the event of
incompetency.)
Yes
No
1. Have you executed a power of attorney?
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☐
R.
2. Is it effective on signing or incapacity?
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3. If you have done so, please bring the document to the meeting
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DIRECTIVE TO PHYSICIANS (LIVING WILL)
The purpose of the Directive to Physicians is to make known the desire of the person signing the
document of his wish not to have his life “artificially prolonged” in the case of any injury, disease, or
terminal condition. Do you wish to have such a document prepared or discuss this further?
Yes
☐
No
☐
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S.
SPECIAL NEEDS/TRUSTS
Are there any special situations for which you would like to consider setting up a trust? An example
of this type of situation is beneficiaries of your estate who may have certain disabilities, or who may
be a minor at the time of distribution, etc. Please indicate if you would like to discuss this further.
Yes
☐
T.
No
☐
Are there any individuals who are currently under the age of 18
to whom you would like to leave money or property ?
Yes
☐
No
☐
Are there any individuals who are currently eligible for
government assistance because of disability or otherwise
to whom you would like to leave money or property?
Yes
☐
No
☐
DOCUMENTS NEEDED
Please provide copies of the following documents. If you are unable to obtain a copy of a document
that exists, please so indicate.
1. Your present will and any amendments.
2. All trust agreements created by you or of which you are a beneficiary.
3. All prenuptial agreements, separation agreements, property settlement agreements, or divorce
decrees to which you are a party.
4. Deeds, mortgage instruments, and any appraisals of real estate owned by you.
5. Copies or summaries of individual or group life insurance policies.
6. Summaries of IRAs owned by you or of which you are a beneficiary.
7. Current statements for savings accounts, money market accounts, or certificates of deposit.
8. If you have an ownership interest in a small or closely-held business, copies of any partnership
agreements, operating agreements, shareholder agreements, articles of incorporation, or bylaws.
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DIGITAL ASSETS WORKSHEET
Examples:
Social networks (Facebook, Twitter, LinkedIn)
Domains & hosting
Blog(s) (Blogger, WordPress, TypePad, self-hosted)
Online gaming (Steam, World of Warcraft)
Photos (Instagram, Snapfish, Flickr)
Documents (Dropbox, Google Drive, iCloud, SkyDrive)
Videos (YouTube, Vimeo)
Financial (banking, investing, retirement accounts)
Books, music & movies (iTunes, Amazon, Google Play)
Online business (Etsy, eBay)
Email & webmail
Computer(s), tablet(s) & smartphone(s)
Name of Account
Username
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Password