Estate Planning Data Gathering

1
Client Name
First Name and Middle Initial
Last Name
2
Client Date of Birth
Date
Month
Day
Year
3
Client Email
example@example.com
4
Client Phone Number
Area Code
Phone Number
5
Spouse's Name
First Name and Middle Initial
Last Name
6
Spouse Date of Birth
Date
Month
Day
Year
7
Spouse Email
example@example.com
8
Spouse Phone Number
Area Code
Phone Number
9
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
General InventoryIf you have the assets listed below, please fill in the blank with the estimated value.
Yes
No
Estimated Value $
Primary Home
Second Home
Rental 1
Rental 2
Rental 3
Commercial Real Estate
Business Interests (LLC's)
Business Checking
Business Savings
Personal Checking
Personal Savings
CD's
Money Market Accounts
Brokerage Accounts (NON-IRA;s)
IRA's
Qualified/Pension/401(k)
Life Insurance Death Benefit
Life Insurance Cash Value
Annuities
Vehicles (personal & Recreational)
Contents of Home
Collectibles (Guns, art, etc...)
Other
Primary Home
Second Home
Rental 1
Rental 2
Rental 3
Commercial Real Estate
Business Interests (LLC's)
Business Checking
Business Savings
Personal Checking
Personal Savings
CD's
Money Market Accounts
Brokerage Accounts (NON-IRA;s)
IRA's
Qualified/Pension/401(k)
Life Insurance Death Benefit
Life Insurance Cash Value
Annuities
Vehicles (personal & Recreational)
Contents of Home
Collectibles (Guns, art, etc...)
Other
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
Yes
No
Estimated Value $
1 of 23
11
Liabilities/DebtIf you have any of the listed below, please fill in the blank with the estimated value.
Yes
No
Estimated Debt
Mortgage(s)
Lines of Credit
Credit Cards
Car Loans
Student Loan
Other
Mortgage(s)
Lines of Credit
Credit Cards
Car Loans
Student Loan
Other
Yes
No
Estimated Debt
Yes
No
Estimated Debt
Yes
No
Estimated Debt
Yes
No
Estimated Debt
Yes
No
Estimated Debt
Yes
No
Estimated Debt
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12
What would you like to Name your Trust?Example: The Smith Family Trust or The Smith Living Trust. You can get creative!
13
Primary BeneficiariesThe main people who will receive your estate
Name
Age
Sex
Relationship
%
#1
Male
Female
#2
Male
Female
#3
Male
Female
#4
Male
Female
#5
Male
Female
#6
Male
Female
#1
#2
#3
#4
#5
#6
Name
Age
Sex
Male
Female
Relationship
%
Name
Age
Sex
Male
Female
Relationship
%
Name
Age
Sex
Male
Female
Relationship
%
Name
Age
Sex
Male
Female
Relationship
%
Name
Age
Sex
Male
Female
Relationship
%
Name
Age
Sex
Male
Female
Relationship
%
1 of 6
14
Is there anyone that you would like to DISINHERIT from your estate?
YESNO
15
Who would you like disinherited?
Name
Relationship
#1
#2
#3
#1
#2
#3
Name
Relationship
Name
Relationship
Name
Relationship
1 of 3
16
Distributions to CONTINGENT BENEFICIARIES"PB" means Primary Beneficiary
Pick ONE
EQUALLY to PB's surviving children - or, if PB leaves no surviving children, then equally to PB's surviving siblings
EQUALLY to PB's surviving siblings-or, if PB leaves no surviving siblings then equally to PB's surviving children.
EQUALLY to PB's surviving children - or, if PB leaves no surviving children, then all to PB's surviving spouse; if PB leaves no surviving spouse, then equally to PB's surviving siblings.
EQUALLY to PB's surviving spouse and children - or, if PB leaves neither a surviving spouse nor surviving children, then equally to PB's surviving siblings
EQUALLY to PB's surviving children - or, if PB leaves no surviving children, then equally to PB's surviving siblings
EQUALLY to PB's surviving siblings-or, if PB leaves no surviving siblings then equally to PB's surviving children.
EQUALLY to PB's surviving children - or, if PB leaves no surviving children, then all to PB's surviving spouse; if PB leaves no surviving spouse, then equally to PB's surviving siblings.
EQUALLY to PB's surviving spouse and children - or, if PB leaves neither a surviving spouse nor surviving children, then equally to PB's surviving siblings
Pick ONE
Pick ONE
Pick ONE
Pick ONE
1 of 4
17
Would you like to add any Age-Based distributions to your estate plan?Ex-You can have the beneficiaries receive 25% of their money broken up and to be distributed at ages 35, 40, 45 and 50
YESNO
18
What ages/percentages do you feel are best?
Huge
Large
Normal
Small
Ok
Ok
19
Do you have a child with special needs and/or are receiving State Benefits?
YESNO
20
What is their name?
First Name & Middle Initial
Last Name
21
Trustee(s)Who do you want to manage your estate when you are BOTH gone or incapable of doing so?
Name
Relationship
#1
#2
#3
#4
#1
#2
#3
#4
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
1 of 4
22
Financial Powers of AttorneyWho can pay your bills and oversee your finances when you are BOTH gone or incapable of doing so?
Name
Relationship
#1
#2
#3
#1
#2
#3
Name
Relationship
Name
Relationship
Name
Relationship
1 of 3
23
Health Care Powers of AttorneyWho can make medical decisions when you are BOTH gone or incapable of doing so?
Name
Relationship
#1
#2
#3
#4
#1
#2
#3
#4
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
1 of 4
24
Do you have children under the age of 18?
YESNO
25
Guardians for Dependent ChildrenWho would you want to care for your children when you are BOTH gone or incapable of doing so?
Name
Relationship
#1
#2
#3
#4
#1
#2
#3
#4
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
1 of 4
Should be Empty:

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