ESTATE PLANNING INTAKE

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.

1st Partner's Legal Name:*

Also Known As:

Birth Date:*

Date

Gender:*

YesNo

Address*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Home Phone:

Format: (000) 000-0000.

Mobile Phone:

Format: (000) 000-0000.

Home E-mail Address:

example@example.com

YesNo

Partner 1 Employer:*

Position:*

Employer Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

2nd Partner’s Legal Name:*

Also Known As:

Birthdate:*

Date

Gender:*

YesNo

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

County:*

Home Phone:

Format: (000) 000-0000.

Mobile Phone:

Format: (000) 000-0000.

Home E-mail Address:

example@example.com

YesNo

Employer:*

Position:*

Employer Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

1st Child’s Legal Name:*

Also Known As:*

Birthdate:*

Date

Gender:*

YesNo

If no, please explain:

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

E-mail Address:

example@example.com

If child is married, spouse’s name:

If child is deceased, date of death:

Date

If child has children, children’s names and birthdates:

YesNo

2nd Child’s Legal Name:*

Also Known As:*

Birthdate:*

Date

Gender:*

YesNo

If no, please explain:

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

E-mail Address:

example@example.com

If child is married, spouse’s name:

If child is deceased, date of death:

Date

If child has children, children’s names and birthdates:

YesNo

3rd Child’s Legal Name:*

Also Known As:*

Birthdate:*

Date

Gender:*

YesNo

If no, please explain:

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

E-mail Address:

example@example.com

If child is married, spouse’s name:

If child is deceased, date of death:

Date

If child has children, children’s names and birthdates:

YesNo

Legal Name:*

Also Known As:

Relationship to You:*

Birthdate:*

Date

Gender:*

YesNo

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

E-mail Address:

example@example.com

YesNo

Legal Name:*

Also Known As:

Relationship to You:*

Birthdate:*

Date

Gender:*

YesNo

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

County:*

Phone Number*

Format: (000) 000-0000.

E-mail Address:

example@example.com

YesNo

1st Pet's Name:

Type of Animal (Dog, Cat):

Age:

YesNo

2nd Pet's Name:

Type of Animal (Dog, Cat):

Age:

YesNo

CPA / Accountant Name:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Advisor Name:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Agent Name:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Attorney Name:*

Phone Number*

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Please explain:

YesNo

Please explain:

YesNo

Please explain:

YesNoNot Applicable

Please explain:

YesNoNot Applicable

Please explain:

YesNo

Please explain:

YesNo

Please explain:

YesNo

General Description and/or Address:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Current Market Value:*

Outstanding Mortgage Balance (if any):*

YesNo

General Description and/or Address:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Current Market Value:*

Outstanding Mortgage Balance (if any):*

YesNo

General Description and/or Address:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Current Market Value:*

Outstanding Mortgage Balance (if any):*

YesNo

1st General Description:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Market Value:*

YesNo

2nd General Description:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Market Value:*

YesNo

General Description:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Current Market Value:*

Outstanding Debt:*

Enter '0' if none.

YesNo

General Description:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Estimated Current Market Value:*

Outstanding Debt:*

Enter '0' if none.

YesNo

Name of Institution:*

Type of Account:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Beneficiary Name:*

YesNo

Name of Institution:*

Type of Account:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Beneficiary Name:*

YesNo

Name of Institution:*

Type of Account:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Beneficiary Name:*

YesNo

1st Institution:

Type of Account:

Owner [Partner 1/Partner 2]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

2nd Institution:

Type of Account:

Owner [Partner 1/Partner 2]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

3rd Institution:

Type of Account:

Owner [Partner 1/Partner 2]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

Name of Institution:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Transfer-on-death beneficiary?

YesNo

Name of Institution:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Transfer-on-death beneficiary?

YesNo

Name of Institution:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Jointly with Others]:*

Current Balance:*

YesNoUnsure

Transfer-on-death beneficiary?

YesNo

1st Institution:*

Type of Policy [Term Life/Whole Life/Variable Life/Universal Life/Group Term Life (Employer-Provided)/Annuity]:*

Amount of Death Benefit:*

Current Cash Value (if any):*

Enter '0' if none.

Owner of Policy [Partner 1/Partner 2/Jointly Together/Trust/Partner 1’s Employer/Partner 2’s Employer/Other]:*

Insured [Partner 1/Partner 2/Both Partners/Other]:*

Primary Beneficiary [Partner 1/Partner 2/Surviving Partner/Trust/Children/Other]:*

Secondary Beneficiary [Partner 1/Partner 2/Surviving Partner/Trust/Children/Other]:*

YesNo

2nd Institution:*

Type of Policy [Term Life/Whole Life/Variable Life/Universal Life/Group Term Life (Employer-Provided)/Annuity]:*

Amount of Death Benefit:*

Current Cash Value (if any):*

Enter '0' if none.

Owner of Policy [Partner 1/Partner 2/Jointly Together/Trust/Partner 1’s Employer/Partner 2’s Employer/Other]:*

Insured [Partner 1/Partner 2/Both Partners/Other]:*

Primary Beneficiary [Partner 1/Partner 2/Surviving Partner/Trust/Children/Other]:*

Secondary Beneficiary [Partner 1/Partner 2/Surviving Partner/Trust/Children/Other]:*

YesNo

1st Business Name:*

Type of Business [LLC/S-Corporation/C-Corporation/Limited Partnership/General Partnership/Other]:*

Description of Business:*

Ownership Percentage:*

Estimated Value of Entire Business:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Other Owners (if any):*

YesNo

2nd Business Name:*

Type of Business [LLC/S-Corporation/C-Corporation/Limited Partnership/General Partnership/Other]:*

Description of Business:*

Ownership Percentage:*

Estimated Value of Entire Business:*

Owner [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Other Owners (if any):

YesNo

1st Debtor Name:*

Name of Lender [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Original Date of Loan:*

Date

Maturity Date:*

Date

Outstanding Balance:*

YesNo

2nd Debtor Name:*

Name of Lender [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Original Date of Loan:*

Date

Maturity Date:*

Date

Outstanding Balance:*

YesNo

Please explain:

YesNo

Please explain:

YesNo

1st Lender Name:*

Name of Debtor [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Purpose of Loan:*

Original Date of Loan:*

Date

Maturity Date:*

Date

Outstanding Balance:*

YesNo

2nd Lender Name:*

Name of Debtor [Partner 1/Partner 2/Jointly Together/Trust/Other]:*

Purpose of Loan:*

Original Date of Loan:*

Date

Maturity Date:*

Date

Outstanding Balance:*

YesNo

Please provide any additional information:

BIOGRAPHICAL INFORMATION

1st PARTNER

2nd PARTNER

CHILDREN

1st CHILD

2nd CHILD

3rd CHILD

OTHER IMPORTANT FRIENDS OR FAMILY MEMBERS

1st PERSON

2nd PERSON

PETS

PROFESSIONAL ADVISORS

IMPORTANT QUESTIONS

PROPERTY INFORMATION

REAL ESTATE

1st PROPERTY

2nd PROPERTY

3rd PROPERTY

PERSONAL PROPERTY

VEHICLES

1st VEHICLE

2nd VEHICLE

DEPOSIT ACCOUNTS

1st ACCOUNT

2nd Account

3rd Account

RETIREMENT PLAN ACCOUNTS

1st ACCOUNT

2nd ACCOUNT

3rd ACCOUNT

TAXABLE INVESTMENT ACCOUNTS

1st ACCOUNT

2nd ACCOUNT

3rd ACCOUNT

LIFE INSURANCE AND ANNUITIES

1st POLICY

2nd POLICY

BUSINESS INTERESTS

1st BUSINESS

2nd BUSINESS

DEBTORS

1st DEBTOR

2nd DEBTOR

GIFTS, INHERITANCES AND OTHER ASSETS

OTHER DEBT

1st LENDER

2nd LENDER

ADDITIONAL INFORMATION