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.

Date of Marriage:*

Date

Legal Name:*

Also Known As:

Birthdate:*

Date

Gender:

YesNo

Home 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

Husband's 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

Wife’s Legal Name:*

Also Known As:

Birthdate:*

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

Employer:

Position:

Employer Address:

Street Address

Street Address Line 2

CityState

Zip Code

County:

Business Phone:

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Legal Name:*

Also Known As:

Birthdate:*

Date

Gender:*

YesNo

Please explain:

Address

Street Address

Street Address Line 2

CityState

Zip Code

County:

Mobile Phone:

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 birth dates.

YesNo

Legal Name:*

Also Known As:

Birthdate:*

Date

Gender:*

YesNo

Please explain:

Address

Street Address

Street Address Line 2

CityState

Zip Code

County:

Mobile Phone:

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 birth dates.

YesNo

Legal Name:*

Also Known As:

Birthdate:*

Date

Gender:*

YesNo

Please explain:

Address

Street Address

Street Address Line 2

CityState

Zip Code

County:

Mobile Phone:

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 birth dates.

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:

Mobile Phone:

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:

Mobile Phone:

Format: (000) 000-0000.

E-mail Address:

example@example.com

YesNo

Name:

Type of Animal (Dog, Cat):

Age:

YesNo

Name:

Type of Animal (Dog, Cat):

Age:

YesNo

Name:

Business Phone:

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Name:

Business Phone:

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Name:

Business Phone:

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Name:

Business Phone:

Format: (000) 000-0000.

Business E-mail Address:

example@example.com

YesNo

Please explain:

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 [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

Outstanding Mortgage Balance (if any):

YesNo

General Description and/or Address:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

Outstanding Mortgage Balance (if any):

YesNo

General Description and/or Address:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

Outstanding Mortgage Balance (if any):

YesNo

1st General Description:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

YesNo

2nd General Description:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

YesNo

1st General Description:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

Outstanding Debt (if any):

YesNo

2nd General Description:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Estimated Current Market Value:

Outstanding Debt (if any):

YesNo

1st Institution:

Type of Account:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the transfer-on-death beneficiary?

YesNo

2nd Institution:

Type of Account:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the transfer-on-death beneficiary?

YesNo

3rd Institution:

Type of Account:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the transfer-on-death beneficiary?

YesNo

1st Institution:

Type of Account:

Owner [Husband/Wife]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

2nd Institution:

Type of Account:

Owner [Husband/Wife]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

3rd Institution:

Type of Account:

Owner [Husband/Wife]:

Current Balance:

YesNoUnsure

Primary beneficiary?

Secondary beneficiary?

YesNo

1st Institution:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the transfer-on-death beneficiary?

YesNo

2nd Institution:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the transfer-on-death beneficiary?

YesNo

3rd Institution:

Owner [Husband/Wife/Jointly Together/Trust/Jointly with Others]:

Current Balance:

YesNoUnsure

If yes, who is the 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):

Owner of Policy [Husband/Wife/Jointly Together/Trust/Husband’s Employer/Wife’s Employer/Other]:

Insured [Husband/Wife/Both Husband and Wife/Other]:

Primary Beneficiary [Husband/Wife/Survivor of Husband and Wife/Trust/Children/Other]:

Secondary Beneficiary [Husband/Wife/Survivor of Husband and Wife/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):

Owner of Policy [Husband/Wife/Jointly Together/Trust/Husband’s Employer/Wife’s Employer/Other]:

Insured [Husband/Wife/Both Husband and Wife/Other]:

Primary Beneficiary [Husband/Wife/Survivor of Husband and Wife/Trust/Children/Other]:

Secondary Beneficiary [Husband/Wife/Survivor of Husband and Wife/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 [Husband/Wife/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 [Husband/Wife/Jointly Together/Trust/Other]:

Other Owners (if any):

YesNo

Debtor 1:

Name of Lender [Husband/Wife/Jointly Together/Trust/Other]:

Original Date of Loan:

Date

Maturity Date:

Date

Outstanding Balance?

YesNo

Debtor 2:

Name of Lender [Husband/Wife/Jointly Together/Trust/Other]:

Original Date of Loan:

Date

Maturity Date:

Date

Outstanding Balance:

YesNo

If yes, please explain:

YesNo

If yes, please explain:

YesNo

Lender 1:

Name of Debtor [Husband/Wife/Jointly Together/Trust/Other]:

Purpose of Loan:

Original Date of Loan:

Date

Maturity Date:

Date

Outstanding Balance:

YesNo

Lender 2:

Name of Debtor [Husband/Wife/Jointly Together/Trust/Other]:

Purpose of Loan:

Original Date of Loan:

Date

Maturity Date:

Date

Outstanding Balance:

YesNo

Please provide any additional related information:

BIOGRAPHICAL INFORMATION

HUSBAND'S INFORMATION

WIFE'S INFORMATION

CHILDREN

1st CHILD

2nd CHILD

3rd CHILD

OTHER IMPORTANT FRIENDS OR FAMILY MEMBERS

1st FRIEND OR FAMILY MEMBER

2nd FRIEND OR FAMILY MEMBER

PETS

1st PET

2nd PET

PROFESSIONAL ADVISORS

IMPORTANT QUESTIONS

PROPERTY INFORMATION

REAL ESTATE

OTHER PROPERTY

VEHICLES

DEPOSIT ACCOUNTS

RETIREMENT PLANS

TAX DEFERRED ACCOUNTS

TAXABLE INVESTMENT ACCOUNTS

LIFE INSURANCE / ANNUITIES

BUSINESS INTERESTS

DEBTORS

GIFTS, INHERITANCES & OTHER

OTHER DEBT

ADDITIONAL INFORMATION