Date:______
CONFIDENTIAL ESTATE PLANNING
INFORMATION
Personal Information
Husband
Full Name:
Birth Date:
Citizenship:
Social Security Number:
Home Address:
Home Telephone:
Employer:
Office Telephone:
Name of Prior Spouse(s)
(if any)
Dependents other than
Children
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________
Children
Name
DOB
1. ________________ ______
2. ________________ ______
3. ________________ ______
4. ________________ ______
5. ________________ ______
6. ________________ ______
Wife
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
Child only of
Husband or Wife
Married
_____________
_____________
_____________
_____________
_____________
_____________
_______
_______
_______
_______
_______
_______
Number of
Children
_______
_______
_______
_______
_______
_______
Do you have any children with Disabilities or Special Needs? If yes, generally describe
the disability: ____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Do you have any Pets for whom you wish to make special provision in the event you
predecease them? If yes, please identify the Pets, and state the name(s) of the persons
who you would wish to care for them: _________________________________________
________________________________________________________________________
________________________________________________________________________
Estate Planning Information -1-
Last Will and Testament
A. Personal Representative, Guardian, Trustee
1. Personal Representative. The personal representative is the person you designate to
identify and collect assets of your estate, pay claims and obligations of the estate, and distribute
the estate assets according to your Will. Spouses often serve for each other; you will also want to
name a successor if the primary nominee cannot serve.
Name of Person
to serve as:
Husband
Wife
Personal Representative (PR)
_________________
________________
Successor PR
_________________
________________
2. Guardian. The Guardian is the individual who will take custody of your minor
children (under age 18) when there is no surviving parent. The Guardian’s role is parental in
nature rather than financial (typically you would appoint a Trustee to administer the assets you
leave to your children). The guardian and trustee will coordinate with each other, and can be the
same person (although, it is generally a better idea to have separate persons serve in these roles).
You should also name a successor guardian in the event the primary nominee is unable or
unwilling to serve. You should discuss this decision thoroughly with the persons you choose
prior to naming them in your Wills. Choosing wisely in this matter is the most important
decision you will make in your Will.
Name of Individual(s) to serve as:
Guardian
________________________
Successor Guardian
________________________
3. Trustee. The Trustee is the individual or entity designated to hold, manage, and
distribute assets placed in any trust(s) established in your Will. The trustee is guided by State
law, and may obtain and rely on the advice of professionals regarding the management of the
assets. Where the trust is for the benefit of your minor children, it is often a good idea to name
the primary trustee as successor guardian and visa versa. There are also many other types of
trusts, however, and you should weigh this choice very carefully. Obvious things to consider
include honesty and ability to handle investment and management of assets.
Name of Individual(s), Entity to serve as:
Trustee
_________________________
Successor Trustee
_________________________
Estate Planning Information -2-
B. Dispositive Provisions in Will (Who do you want to get your assets)
1. If Married:
(a) Outright to Spouse? Most spouses desire to leave their share of the estate to their
spouse free and clear; however, you are not required to do this, and there may be circumstances
where it is wise not to do so. For example, if you have a taxable estate you may want to leave
assets to your spouse in trust. Also, if you have children from a prior marriage for whom you
wish to provide, you can do this by a trust (or other means), whereby you can both provide for the
needs of your spouse during life, and increase the likelihood that your children will get something
(either on your death or on the death of your spouse). Please consider your thoughts in this
regard and we can discuss this issue at our consultation. ________________________________
______________________________________________________________________________
______________________________________________________________________________
(b) Trust for Minor Children. If you have minor children it is a good idea to establish a
trust in your Will to hold your estate for their benefit if both parents die when the children are still
young. The provisions of the trust would generally allow the trustee to make payments for the
health, support, and education of the children. At some point, a child’s share is usually
distributed to him/her outright and the trust terminates. The termination should be at the age or
ages at which the child can be expected to manage the funds independently. For example, ½ of a
child’s share could be distributed to the child at age 25 with the balance 5 years later. If you
would like a trust for your children, at what ages would you like to see final distribution; and do
you have thoughts about special provisions in the trust (i.e., a greater amount going to a child
with greater needs, etc.). _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(c) Gifts to Individuals other than Spouse or Descendants. Do either of you wish to make
gifts in your Will to individuals (i.e., parents, siblings, pets, etc.) or entities (such as charities)
other than to your spouse or descendants (children and grandchildren)? ______. If yes, please
specify names and amounts (or percentages). _________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(d) Neither Spouse Nor Descendant Survive. In the event neither your spouse nor any of
your descendants survive the complete distribution of your estate, please name the individual(s)
or charities to whom you would like to leave such remaining estate. _______________________
______________________________________________________________________________
______________________________________________________________________________
2. If Single. Please state your wishes as to which individuals, charities, etc., for whom
you would like to provide, indicating the approximate amount or percentage interest each would
receive from your estate (also include addresses)._______________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Estate Planning Information -3-
3. Special Concerns. Are there any additional concerns or questions about disposition
of your estate that are not discussed above? ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other Documents
A. General Financial Durable Power of Attorney. This document allows you to
appoint an individual to make decisions and take actions regarding your financial affairs in the
event you ever become incapacitated. Typically, this document does not take effect until or
unless you become incapacitated (written evidence from your doctor is required to establish this),
and is a very effective way to avoid a very costly and lengthy guardianship process (which would
be required in the event you become incapacitated and do not have a power of attorney).
Name of Individual to serve as:
Husband
Wife
Primary Attorney-in-Fact
(Phone Number)
Alternate Attorney-in-Fact
(Phone Number)
_________________
_________________
_________________
_________________
_________________
_________________
_________________
_________________
NOTE: The issue of Medicaid Planning often arises in preparing this Power of Attorney.
This is particularly important if you are older and/or have a history in your family of dementia,
strokes, or other problems that can lead to long-term disability. Please make any notes if this
issue is of concern to you, and we will discuss it at our meeting.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
B. Medical Power of Attorney. A medical power of attorney allows your nominee to
make decisions regarding your medical treatment and related issues. It is a good idea to make
this effective upon signing; however, as long as you are competent or are conscious, a physician
will look only to you for decisions regarding treatment. You should give a copy of this document
to your physician after it has been executed.
Name of Individual to serve as:
Husband
Wife
Primary Medical Attorney-if-Fact
(Phone Number)
Alternate Medical Nominee
(Phone Number)
________________
________________
________________
________________
___________________
___________________
___________________
___________________
C. Health Care Directive. This document (also referred to as a “living will”) is a
statutory form designed to provide for the withdrawal of artificial life support systems (such as
feeding tubes) if you are diagnosed to be in a “terminal condition” or in a “permanently
unconscious condition. This document is only effective in situations where you are (1)
unconscious, (2) where death is immanent, and (3) with where there is no chance of recovery).
Would you be interested in such a document? ________________________________________
Estate Planning Information -4-
D. Community Property Agreement. This is an Agreement between spouses that will
provide that all of the couples’ property will pass to the survivor upon the death of the first
spouse. This primary benefit of this document is that it will avoid the need for a probate upon the
death of the first spouse; and it should be seriously consider where there is a stable, long-term
marriage and you want all your property to pass to your spouse upon your death. This document
is often not a good idea in some situations, including the following: where there are large estates
with tax issues, where yours is a second marriage and you have children from a prior marriage for
whom you wish to provide, for relatively short-term marriages or where the marriage is unstable.
We will discuss this document at our consultation.
Existing Documents. Please provide me with copies of any existing estate planning
documents, including Wills, Powers of Attorney, Community Property Agreements, Prenuptial
Agreements, Living Wills, and other documents about which you have questions.
Advisors:
Investments: _________________________________________________
Accountant: __________________________________________________
Insurance: __________________________________________________
ASSETS AND LIABILITIES
A. Assets
Separate Property
Wife
Community
Property
- Checking & Saving Account $______________
_______________
____________
- Shortterm Investments
(CD’s, Money Market, etc.)
$______________
_______________
____________
- Stocks and Bonds
$______________
________________
_____________
- Annuities
$______________
_________________
_____________
- Principal Residence
(address)
$______________
_________________
_____________
- Vacation Property
(address)
$_______________ _________________
_____________
- Other real estate
(addresses)
$______________
_________________
_____________
- Debts owed to you
$______________
_________________
_____________
Estate Planning Information -5-
Separate Property
Husband
Husband
Wife
Community
- Face Value of Life Insurance _______________ _________________
(List Policies by amount, beneficiary, name of insurer)
1.
2.
3.
_____________
- Retirement Benefits
_______________
(List each IRA/401K etc., including amounts,
name of beneficiary, and holder of account)
1.
2.
3.
_________________
_____________
- Valuable Furishings/Jewelry ________________ _________________
(List only items such as jewelry, antiques, etc.,
that are worth at least $1,000)
_____________
- Automobiles & Boats
________________ _________________
_____________
- Other (specify)
________________ _________________
_____________
________________ _________________
_____________
Total Assets
B. Liabilities (List only significant debts, such as mortgages,
major credit card debt, etc.)
________________ __________________ _____________
________________ __________________ _____________
Total Liabilities
________________ __________________ _____________
The reason we ask for information about assets is partly to determine if you have
any issues regarding estate tax; and partly to ensure that the beneficiary’s in your Wills are
the same persons that would get the asset under any beneficiary designations in things such
as life insurance contract, money and/or investment accounts. It is very important that the
Will and specific beneficiary designations be in accord.
Estate Planning Information -6-
General Information
Husband
Wife
1. Estimate size of future inheritance
_____________
_______________
2. Are you currently a Trustee or
beneficiary of any trust? Specify.
_____________
_______________
3. Have you ever made any gifts in
_____________
excess of $10,000 to any individual
in any one year? Specify.
_______________
4. Do you own any property outside
the State of Washington? Specify.
_______________
_____________
Questions That You Have. In this space you should make a list of any questions you may have,
and we can discuss them at our initial consultation.
-
Upon Completion call Jon Clark at (206) 675-0803 for appointment, and bring this
completed form with you.
Law Office of Jon A. Clark
5413 Meridian Ave. N. Suite A
Seattle, WA 98103
Estate Planning Information -7-