• ESTATE PLANNING INTAKE

    ESTATE PLANNING INTAKE

    WORKSHEET FOR INDIVIDUAL

  • Please complete this worksheet at your earliest convenience. Estimated values for assets and liabilities are fine. If you run out of space for any question, please include that information in the “Additional Information” section at the end of the worksheet.

  • BIOGRAPHICAL INFORMATION

  • Birthdate:*
     / /
  • US Citizen?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Are You Currently Employed?*
  • Format: (000) 000-0000.

  • CHILDREN

  • Do you now or have you ever had children?*

  • 1st CHILD

  • Birthdate:
     / /
  • US Citizen?
  • Format: (000) 000-0000.
  • If child is deceased, date of death:
     / /
  • Do You Have a 2nd Child?

  • 2nd CHILD

  • Birthdate:
     / /
  • US Citizen?
  • Format: (000) 000-0000.
  • If child is deceased, date of death:
     / /
  • Do You Have a 3rd Child?

  • 3rd CHILD

  • Birthdate:
     / /
  • Citizen?
  • Format: (000) 000-0000.
  • If child is deceased, date of death:
     / /

  • OTHER IMPORTANT FRIENDS OR FAMILY MEMBERS

  • Are there any important friends or family members that you may include in your estate plan (for example, as a beneficiary or executor of your estate)?*

  • 1st FRIEND OR FAMILY MEMBER

  • US Citizen?
  • Birthdate:
     / /
  • Format: (000) 000-0000.
  • Add Another Friend or Family Member?

  • 2nd FRIEND OR FAMILY MEMBER

  • Birthdate:
     / /
  • US Citizen?
  • Format: (000) 000-0000.

  • PETS

  • Do you have any pets?*
  • Another pet?

  • PROFESSIONAL ADVISORS

  • CPA / ACCOUNTANT

  • Do you have a CPA or accountant?*
  • Format: (000) 000-0000.

  • FINANCIAL / WEALTH MANAGEMENT ADVISOR

  • Do you have a financial or wealth management advisor?*
  • Format: (000) 000-0000.

  • LIFE INSURANCE AGENT

  • Do you have a life insurance agent?*
  • Format: (000) 000-0000.

  • BUSINESS, TAX or OTHER ATTORNEYS

  • Do you have other attorneys (business, tax, etc.)*
  • Format: (000) 000-0000.

  • IMPORTANT QUESTIONS

  • Have you completed previous will, trust or estate planning?*
  • Are you receiving Social Security, disability, or other governmental benefits?*
  • Are you making payments pursuant to a divorce or property settlement order?*
  • Have you ever been widowed?*
  • Have you ever filed a federal or state gift tax return?*
  • Have you chosen any charitable organizations that you wish to make provisions for at the time of your death?*
  • To your knowledge, are you the current or remainder beneficiary of anyone else’s revocable or irrevocable trust (parents, grandparents)?*
  • Do any of your children have special educational, medical or physical needs?*
  • Do any of your children receive governmental support or benefits?*
  • Do you provide primary or other major financial support to adult children or others?*
  • Are there any specific goals or concerns that you would like to address in your estate plan?*

  • PROPERTY INFORMATION

  • Do you own any real estate (personal residence, vacation home, vacant land, timeshare)?*

  • PROPERTY 1

  • Is there a 2nd Property?

  • PROPERTY 2

  • Is there a 3rd Property?

  • PROPERTY 3

  • SIGNIFICANT PERSONAL PROPERTY

  • Other than ordinary household furnishings and personal effects, do you own any personal property of significant financial value (jewelry, artwork, collectibles, etc)?*
  • Insured?
  • Insured?

  • AUTOMOBILES, BOATS, RVs or OTHER VEHICLES

  • Do you own any automobiles, boats, recreational vehicles (RV) or other vehicles?*
  • Insured?
  • Insured?

  • DEPOSIT ACCOUNTS

  • Do you own any deposit accounts (checking, savings, money market, CDs)?*
  • Have you named a transfer-on-death beneficiary?
  • Have you named a transfer-on-death beneficiary?
  • Have you named a transfer-on-death beneficiary?

  • RETIREMENT PLANS

  • Do you own any retirement plans (401(k), 403(b), Traditional or Roth IRAs, etc)?*
  • Have you named a primary and secondary beneficiary?
  • Have you named a primary and secondary beneficiary?
  • Have you named a primary and secondary beneficiary?

  • TAXABLE INVESTMENT ACCOUNTS

  • Do you own any taxable investment accounts?*
  • Have you named a transfer-on-death beneficiary?
  • Have you named a transfer-on-death beneficiary?
  • Have you named a transfer-on-death beneficiary?

  • LIFE INSURANCE POLICIES OR ANNUITIES

  • Are you the owner, insured or beneficiary of any life insurance policies or annuities?*

  • CLOSELY HELD BUSINESS INTERESTS

  • Do you own any closely held business interests?*
  • Have you entered into any Shareholder Agreements, Operating Agreements or Buy-Sell Agreements?
  • Have you entered into any Shareholder Agreements, Operating Agreements or Buy-Sell Agreements?

  • DEBTORS

  • Does anyone owe any money to you?*
  • Original Date of Loan:
     / /
  • Maturity Date:
     / /
  • Secured?
  • Did you document the loan with a written Promissory Note?
  • Original Date of Loan:
     / /
  • Maturity Date:
     / /
  • Secured?
  • Did you document the loan with a written Promissory Note?

  • GIFTS, INHERITANCES AND OTHER ASSETS

  • Do you anticipate receiving any gifts or inheritances from a third party (parents, grandparents, trust distributions) at some time in the future?*
  • Do you have any other significant assets that do not fit into any of the above categories (whether significant for financial or sentimental reasons)?*

  • OTHER DEBT

  • Other than mortgages and loans already referenced above, do you have any outstanding debt?*
  • Original Date of Loan:
     / /
  • Maturity Date:
     / /
  • Secured?
  • Original Date of Loan:
     / /
  • Maturity Date:
     / /
  • Secured?

  • ADDITIONAL INFORMATION

  •  
  • Should be Empty: