Family Wealth Inventory & Assessment
I look forward to meeting you!
Instructions:
To make the most of our time together, we must have your Family Wealth Inventory & Assessment completed at least 3 days prior to your Planning Session so we have enough time to understand the specifics of your family wealth prior to out meeting. Please note that this Assessment will take approximately 45 minutes to an hour to complete.
Please Note:
***You may save and return to your work at any time by clicking "Save" at the bottom of a page. When prompted, please enter your e-mail address so that a unique URL will be sent to you that saves your information. You MUST enter your email address on that page in order to save your work. We CANNOT retrieve it for you.***
Don't Work About Total Accuracy - Just Do The Best You Can.
All information is strictly confidential.
I look forward to working with you.
All information is strictly confidential.
Your Information
(If you are married, we'll gather your spouse's information next)
Your Signature Name (name most often used to title property and accounts)
First Name
Last Name
Your Name As It Appears on Driver's License or Passport
First Name
Last Name
Also Known As (any other names used to title property and accounts)
Your Email Address
example@example.com
Your Phone Number
-
Area Code
Phone Number
US Citizen?
Yes
No
Your Date of Birth
-
Month
-
Day
Year
Date
Your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status
Single
Married
Your Date of Marriage
-
Month
-
Day
Year
Date
Do You Have Children and/or Others Who Depend on You? (check all that apply)
I have adult children
I have minor children
I have no children
I have others who depend on me
Do You Have Pets?
Yes
No
Where Are You From (Your Hometown)?
What's Your Occupation?
Who is Your Employer? (Or If Retired, Who Was Your Employer?)
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Your Spouses's Information
Your Signature Name (name most often used to title property and accounts)
First Name
Last Name
Your Name As It Appears on Driver's License or Passport
First Name
Last Name
Also Known As (any other names used to title property and accounts)
Your Email Address
example@example.com
Your Phone Number
-
Area Code
Phone Number
US Citizen?
Yes
No
Your Date of Birth
-
Month
-
Day
Year
Date
Where Are You From (Your Hometown)?
What's Your Occupation?
Who is Your Employer? (Or If Retired, Who Was Your Employer?)
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All Children (a well as Anyone Who Depends on You)
No. 1 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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No. 2 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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No. 3 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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No. 4 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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No. 5 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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No. 6 Full Name
Relationship to You
Date of Birth
-
Month
-
Day
Year
Date
Living or Deceased
Living
Deceased
Would you want to protect what you leave this child from any future divorce or creditors?
Yes
No
Do you have more children?
Yes
No
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Your Family Wealth Advisors
It's helpful for us to know of your existing advisors so that we can work in partnership with them when necessary. We're more than happy to give you a referral when desired.
Do You Have Trusted Family Wealth Advisors (such as a Financial Advisor, Life Insurance Agent, Accountant, or Realtor?)
Yes
No
No. 1: Type:
Financial Advisor
Life Insurance Agent
Accountant
Realtor
Other
Name
Company
City & State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do You Have Additional Advisors?
Yes
No
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No. 2: Type:
Financial Advisor
Life Insurance Agent
Accountant
Realtor
Other
Name
Company
City & State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do You Have Additional Advisors?
Yes
No
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No. 3: Type:
Financial Advisor
Life Insurance Agent
Accountant
Realtor
Other
Name
Company
City & State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do You Have Additional Advisors?
Yes
No
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No. 4: Type:
Financial Advisor
Life Insurance Agent
Accountant
Realtor
Other
Name
Company
City & State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Your Planning Objectives
Please identify ALL the reasons you are considering planning or areas you would like to learn more about (select as many as you wish).
Preserve and Maximize Assets
Minimizing taxes during our life (income taxes, capital gains taxes, estate taxes on inheritances you expect to receive)
Minimizing or eliminating estates taxes upon your death
Reducing estate administration costs through probate avoidance
Ensuring your family has enough life insurance to provide a comfortable lifestyle
Ensuring your assets are passed to your descendants and not given away to outsiders, such as creditors, or the government
Ensuring a special needs beneficiary has assets that are protected from government seizure while retaining eligibility for needed services
Protect Yourself and Your Spouse
From malpractice or other creditor claims
From conservatorship proceedings if you become incapacitated
From probate delays and stress after your death or your spouse's death
From hospital policies requiring life sustaining procedures when you would rather not endure them
From healthcare decision made by people other than those you trust more
Protect Your Children or Other Beneficiaries
From predators who can discover inheritance amounts and target young or vulnerable beneficiaries
From claims of divorced spouses to take half of your child or beneficiary's inheritance
From malpractice claims, for beneficiaries with a professional practice
From other creditors' claims (such as car accident plaintiffs)
From the stress and delays of the average 9-16 month process of probate
From sharing assets with heirs you would rather disinherit
From litigation claims by disinherited heirs
For parents only: from relatives who would be poor, abusive, or dangerous guardians, or from foster care
For parents only: from acquaintances and relatives who should not be allowed to be alone with your children
For special needs beneficiary only: from neglect in the government care system
Take Care of Your Life
Get you financial life organized
Have clarity about your life purpose, goals, and dreams
Benefit a charitable organization or activity
Support a common family goal through coordinated planning
For special needs beneficiary only: by providing instructions, people, and assets to support your special needs beneficiaries above a poverty lifestyle
For business owners only: by providing for the orderly continuation and transfer of family business interests rather than a distress sale
From litigation claims by disinherited heirs
For parents only: from relatives who would be poor, abusive, or dangerous guardians, or from foster care
For parents only: from acquaintances and relatives who should not be allowed to be alone with your children
For special needs beneficiary only: from neglect in the government care system
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Your Existing Legal Documents
Do You Have an Existing Will or Other Estate Planning Documents?
Yes
No
Are You Currently Making Payments Pursuant to a Divorce Decree?
Yes
No
Have You and Your Spouse Signed a Pre-Marital or Post-Marital Agreement?
Yes
No
Have You Ever Filed Federal or State Gift Tax Returns?
Yes
No
Do You Have Any Frozen Eggs, Sperm, or Embryos That Might Be Used in the Future?
Yes
No
Please Upload Copies of Applicable Documents To Your Secure Portal For All "Yes" Responses Above
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Important Family Questions
Do Any of Your Intended Beneficiaries Have a Disability or Serious Health Problem?
Yes
No
Please Describe
Do You Support Charitable Organizations You're Considering Naming in Your Estate Plan?
Yes
No
Please Describe
Are You Currently the Trustee or Executor of, or Receiving Income from, a Trust (Revocable or Irrevocable) or Estate, or Waiting on a Distribution of an Ongoing Trust or Estate Administration?
Yes
No
Please Describe
Are You Anticipating Monies By Way of a Judgment in a Lawsuit?
Yes
No
Please Describe
Have You or Your Spouse Been Diagnosed with a Illness such as Alzheimer's, Dementia, or Similar, or Have You Suffered a Major Stroke?
Yes
No
Please Describe
Do You Own a Business?
Yes
No
Do You Own a Long-Term Care (Nursing Home) Insurance Policy?
Yes
No
Any Additional Information or Anything Else You Want to Tell Us?
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Your Monthly Income
Earned Income $
Social Security Income $
Pension Income
Interest or Royalty Income $
Rental Income $
Disability Income (e.g. SSA, Workers Comp, Veterans) $
Other Income $
Your Spouses's Monthly Income
Earned Income $
Social Security Income $
Pension Income
Interest or Royalty Income $
Rental Income $
Disability Income (e.g. SSA, Workers Comp, Veterans) $
Other Income $
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Real Estate
(Residence, Rental, Vacation Home, Vacant Land, Mineral Interest, Deeded Timeshare)
Do You Own Any Real Estate?
Yes
No
Property No. 1 Type
Residence
Rental
Vacation Home
Vacant Land
Mineral Interest
Timeshare
Other
Owner Name(s)
Property Address
Property County
Market Value $
Mortgage Balance $
Do You Have Additional Property?
Yes
No
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Property No. 2 Type
Residence
Rental
Vacation Home
Vacant Land
Mineral Interest
Timeshare
Other
Owner Name(s)
Property Address
Property County
Market Value $
Mortgage Balance $
Do You Have Additional Property?
Yes
No
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Property No. 3 Type
Residence
Rental
Vacation Home
Vacant Land
Mineral Interest
Timeshare
Other
Owner Name(s)
Property Address
Property County
Market Value $
Mortgage Balance $
Do You Have Additional Property?
Yes
No
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Property No. 4 Type
Residence
Rental
Vacation Home
Vacant Land
Mineral Interest
Timeshare
Other
Owner Name(s)
Property Address
Property County
Market Value $
Mortgage Balance $
Do You Have Additional Property?
Yes
No
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Property No. 5 Type
Residence
Rental
Vacation Home
Vacant Land
Mineral Interest
Timeshare
Other
Owner Name(s)
Property Address
Property County
Market Value $
Mortgage Balance $
Do You Have Additional Property?
Yes
No
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Bank Accounts and Safe Deposit Boxes
(Checking, Savings, Money Market, CDs, Safe Deposit Boxes. NOTE: Do Not Include Retirement Accounts others Which You Will List on Another Page). There are additional pages for 1) Investment Accounts, 2) Retirement Accounts, 3) Custodial & Educational Accounts, and 4) Life Insurance.
Do You Own Any Bank Accounts, Safe Deposit Boxes, Etc. (see list above)?
Yes
No
Account No. 1 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 2 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 3 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 4 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 5 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 6 Type
Checking
Savings
Money Market
CDs
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Investment Accounts
(Brokerage, Mutual Funds, Non-Qualified Annuities, Stock Certificates. NOTE: Do Not Include Retirement Accounts, Which You Will List on the Next Page).
Do You Own Any Investment Accounts?
Yes
No
Account No. 1 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 2 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 3 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 4 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 5 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 6 Type
Brokerage
Mutual Funds
Non-Qualified Annuities
Stock Certificates
Safe Deposit Box
Other
Owner Name(s)
Financial Institution
Balance $
Do You Have Additional Accounts of this Type?
Yes
No
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Retirement Accounts
(Traditional IRA, 401(k), Roth IRA, SEP, 403(b), Pension, Profit Sharing, Qualified Annuity)
Do You Own Any Retirement Accounts?
Yes
No
Account No. 1 Type
Traditional IRA
401(k)
Roth IRA
SEP
403(b)
Pension
Profit Sharing
Qualified Annuity
Other
Owner Name(s)
Financial Institution
Balance $
Primary Beneficiary
Contingent Beneficiary
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 2 Type
Traditional IRA
401(k)
Roth IRA
SEP
403(b)
Pension
Profit Sharing
Qualified Annuity
Other
Owner Name(s)
Financial Institution
Balance $
Primary Beneficiary
Contingent Beneficiary
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 3 Type
Traditional IRA
401(k)
Roth IRA
SEP
403(b)
Pension
Profit Sharing
Qualified Annuity
Other
Owner Name(s)
Financial Institution
Balance $
Primary Beneficiary
Contingent Beneficiary
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 4 Type
Traditional IRA
401(k)
Roth IRA
SEP
403(b)
Pension
Profit Sharing
Qualified Annuity
Other
Owner Name(s)
Financial Institution
Balance $
Primary Beneficiary
Contingent Beneficiary
Do You Have Additional Accounts of this Type?
Yes
No
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Account No. 5 Type
Traditional IRA
401(k)
Roth IRA
SEP
403(b)
Pension
Profit Sharing
Qualified Annuity
Other
Owner Name(s)
Financial Institution
Balance $
Primary Beneficiary
Contingent Beneficiary
Do You Have Additional Accounts of this Type?
Yes
No
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Custodial and Educational Accounts
(529, Education Savings Accounts, UTMA)
Are You the Custodian of Any Accounts for Your Children or Other Beneficiaries, or Are You in Control of Any Educational Accounts for Your Children or Other Beneficiaries?
Yes
No
Account No. 1 Type
529
Educational Savings Account
UTMA
Other
Beneficiary Name
Custodian Name(s)
Financial Institution
Balance $
Are There Additional Custodial or Accounts?
Yes
No
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Account No. 2 Type
529
Educational Savings Account
UTMA
Other
Beneficiary Name
Custodian Name(s)
Financial Institution
Balance $
Are There Additional Custodial or Accounts?
Yes
No
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Account No. 3 Type
529
Educational Savings Account
UTMA
Other
Beneficiary Name
Custodian Name(s)
Financial Institution
Balance $
Are There Additional Custodial or Accounts?
Yes
No
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Account No. 4 Type
529
Educational Savings Account
UTMA
Other
Beneficiary Name
Custodian Name(s)
Financial Institution
Balance $
Are There Additional Custodial or Accounts?
Yes
No
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Life Insurance and Other Types of Insurance
Do You Own Any Life Insurance Policies or Other Types of Insurance Policies?
Yes
No
Policy No. 1 Type
Whole Life
Term Like
Universal Life
Group Life
AD&D
Business Travel Accident
Supplement or Optional Coverage
Spouse or Dependent Coverage
Other
Owner Name
Insured Name
Financial Institution
Death Benefit $
Cash Value $
Primary Beneficiary
Contingent Beneficiary
Are There Additional Insurance Policies?
Yes
No
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Policy No. 2 Type
Whole Life
Term Like
Universal Life
Group Life
AD&D
Business Travel Accident
Supplement or Optional Coverage
Spouse or Dependent Coverage
Other
Owner Name
Insured Name
Financial Institution
Death Benefit $
Cash Value $
Primary Beneficiary
Contingent Beneficiary
Are There Additional Insurance Policies?
Yes
No
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Policy No. 3 Type
Whole Life
Term Like
Universal Life
Group Life
AD&D
Business Travel Accident
Supplement or Optional Coverage
Spouse or Dependent Coverage
Other
Owner Name
Insured Name
Financial Institution
Death Benefit $
Cash Value $
Primary Beneficiary
Contingent Beneficiary
Are There Additional Insurance Policies?
Yes
No
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Policy No. 4 Type
Whole Life
Term Like
Universal Life
Group Life
AD&D
Business Travel Accident
Supplement or Optional Coverage
Spouse or Dependent Coverage
Other
Owner Name
Insured Name
Financial Institution
Death Benefit $
Cash Value $
Primary Beneficiary
Contingent Beneficiary
Are There Additional Insurance Policies?
Yes
No
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Businesses
(Privately Owned Corporation, Limited Liability Company, General or Limited Partnership, Sole Proprietorship, Oil Interest, Farm or Ranch Interest)
Do You Own Any Businesses
Yes
No
Business No. 1 Type
Privately Owned Corporation
Limited Liability Company General or Limited Partnership
Sole Proprietorship
Oil Interest
Farm or Ranch Interest
Business Legal Name
State of Organization
Business Address
Your Percentage Ownership
Value of Your Percentage Ownership
Do You Own Any Other Businesses
Yes
No
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Business No. 2 Type
Privately Owned Corporation
Limited Liability Company General or Limited Partnership
Sole Proprietorship
Oil Interest
Farm or Ranch Interest
Business Legal Name
State of Organization
Business Address
Your Percentage Ownership
Value of Your Percentage Ownership
Do You Own Any Other Businesses
Yes
No
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Business No. 3 Type
Privately Owned Corporation
Limited Liability Company General or Limited Partnership
Sole Proprietorship
Oil Interest
Farm or Ranch Interest
Business Legal Name
State of Organization
Business Address
Your Percentage Ownership
Value of Your Percentage Ownership
Do You Own Any Other Businesses
Yes
No
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Business No. 4 Type
Privately Owned Corporation
Limited Liability Company General or Limited Partnership
Sole Proprietorship
Oil Interest
Farm or Ranch Interest
Business Legal Name
State of Organization
Business Address
Your Percentage Ownership
Value of Your Percentage Ownership
Do You Own Any Other Businesses
Yes
No
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Monies Owed To You
(Signed Promissory Notes for Loans You've Made to Others)
Does Anyone Owe You Money and Did They Sign a Promissory Note?
Yes
No
No. 1 Debtor's Name(s)
Date of Note
-
Month
-
Day
Year
Date
Term (in Years or Months)
Principal Balance $
Cureent Balance $
Are There Additional Promissory Notes Payable to You?
Yes
No
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No. 2 Debtor's Name(s)
Date of Note
-
Month
-
Day
Year
Date
Term (in Years or Months)
Principal Balance $
Cureent Balance $
Are There Additional Promissory Notes Payable to You?
Yes
No
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No. 3 Debtor's Name(s)
Date of Note
-
Month
-
Day
Year
Date
Term (in Years or Months)
Principal Balance $
Cureent Balance $
Are There Additional Promissory Notes Payable to You?
Yes
No
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Vehicles, Boats, Motor Homes, and Mobile Homes
(Anything with a Title)
Do You Own Any Vehicles, Boats, Motor Homes, or Mobile Homes?
Yes
No
No. 1 Type
Vehicle
Boat
Motor Home
Mobile Home
Year Make & Model
Owner Name(s)
Market Value $
Loan Balance $
Do You Own Additional Vehicles, Boats, Motor Homes, or Mobile Homes?
Yes
No
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No. 2 Type
Vehicle
Boat
Motor Home
Mobile Home
Year Make & Model
Owner Name(s)
Market Value $
Loan Balance $
Do You Own Additional Vehicles, Boats, Motor Homes, or Mobile Homes?
Yes
No
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No. 3 Type
Vehicle
Boat
Motor Home
Mobile Home
Year Make & Model
Owner Name(s)
Market Value $
Loan Balance $
Do You Own Additional Vehicles, Boats, Motor Homes, or Mobile Homes?
Yes
No
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No. 4 Type
Vehicle
Boat
Motor Home
Mobile Home
Year Make & Model
Owner Name(s)
Market Value $
Loan Balance $
Do You Own Additional Vehicles, Boats, Motor Homes, or Mobile Homes?
Yes
No
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Valuable Personal Property
(Jewelry, Furniture, Artwork, Antiques, Etc.
No. 1 Description of Property
Owner Name(s)
Approximate Value $
Do You Have More Valuable Personal Property?
Yes
No
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No. 2 Description of Property
Owner Name(s)
Approximate Value $
Do You Have More Valuable Personal Property?
Yes
No
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No. 3 Description of Property
Owner Name(s)
Approximate Value $
Do You Have More Valuable Personal Property?
Yes
No
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No. 4 Description of Property
Owner Name(s)
Approximate Value $
Do You Have More Valuable Personal Property?
Yes
No
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Foreign, Other, or Unusual Assets
(Foreign Assets, Copyrights, Trademarks, or Other Assets)
Do You Own any Foreign, Other, or Unusual Assets?
Yes
No
No. 1 Description of Assets (and location if foreign)
Owner Name(s)
Approximate Value $
Do You Have Additional Foreign, Other, or Unusual Assets?
Yes
No
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No. 2 Description of Assets (and location if foreign)
Owner Name(s)
Approximate Value $
Do You Have Additional Foreign, Other, or Unusual Assets?
Yes
No
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No. 3 Description of Assets (and location if foreign)
Owner Name(s)
Approximate Value $
Do You Have Additional Foreign, Other, or Unusual Assets?
Yes
No
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Unsecured Debt
(Credit Cards, Student Loans, Personal Lines of Credit, Etc.)
Do You Owe on Any Credit Cards, Student Loans, Personal Lines of Credit, or Other Unsecured Debt?
Yes
No
No. 1 Type
Student Loan
Credit Card
Personal Line of Credit
Persona Guaranty on Business
Other
Debtor Name(s)
Lender
Balance Owed $
Additional Unsecured Debt?
Yes
No
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No. 2 Type
Student Loan
Credit Card
Personal Line of Credit
Persona Guaranty on Business
Other
Debtor Name(s)
Lender
Balance Owed $
Additional Unsecured Debt?
Yes
No
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No. 3 Type
Student Loan
Credit Card
Personal Line of Credit
Persona Guaranty on Business
Other
Debtor Name(s)
Lender
Balance Owed $
Additional Unsecured Debt?
Yes
No
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No. 4 Type
Student Loan
Credit Card
Personal Line of Credit
Persona Guaranty on Business
Other
Debtor Name(s)
Lender
Balance Owed $
Additional Unsecured Debt?
Yes
No
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Potential Beneficiaries
Please identify all potential beneficiaries of your estate. Note: Listing a person or organization is not a firm indication of your decision. It is simply a way of identifying potential beneficiaries.
No. 1 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
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No. 2 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
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No. 3 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
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No. 4 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
Back
Next
Save
No. 5 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
Back
Next
Save
No. 6 Type
Individual
Organization
First & Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Dollar Amount or Percentage
Other Potential Beneficiaries?
Yes
No
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Potential Short-Term Guardians
Who is local and immediately available to be with your children in an emergency if you could not be located or are injured? At least 3 individuals are recommended.
(Note: Once you have identified a person once and provided their contact info, uo can identify them on subsequent pages simply by name - you don't beed to repeat their contact information).
No. 1 First & Last Name
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No. 2 First & Last Name
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No. 3 First & Last Name
Relationship to You
City & State
Email
example@example.com
Phone Number
-
Area Code
Phone Number
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Potential Long-Term Guardians
Who would raise your children in the same manner you would if something happened to you? At least 3 individuals are recommended.
Long-Term Guardian No. 1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Long-Term Guardian No. 2 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Long-Term Guardian No. 3 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
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Potential Successor Trustees or Executors
Who do you trust to make financial decisions on behalf of your children or beneficiaries if something happened to you? At least 3 individuals are recommended.
Potential Trustee/Executor No.1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Potential Trustee/Executor No.2 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Potential Trustee/Executor No.3 First & Last Name
Relationship to You
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Potential Financial Powers of Attorney
If you're unable to make decisions for yourself, who should make decisions for you with regard to your financial affairs? At least 3 individuals are recommended.
Your Selections
Your Spouses's Selections will go on the Next Page
No.1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.2 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.3 First & Last Name
Relationship to You
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Back
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Save
Potential Financial Powers of Attorney
If you're unable to make decisions for yourself, who should make decisions for you with regard to your financial affairs? At least 3 individuals are recommended.
Spouse Selections
No.1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.2 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.3 First & Last Name
Relationship to You
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Back
Next
Save
Potential Medical Powers of Attorney
If you're unable to make decisions for yourself, who should make decisions for you with regard to your financial affairs? At least 3 individuals are recommended.
Your Selections
Your Spouses's Selections will go on the Next Page
No.1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.2 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.3 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Back
Next
Save
Potential Medical Powers of Attorney
If you're unable to make decisions for yourself, who should make decisions for you with regard to your financial affairs? At least 3 individuals are recommended.
Spouse Selections
No.1 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.2 First & Last Name
Save
Submit
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
No.3 First & Last Name
Relationship to You
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Back
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Final Details
We want to make sure you get the most out of your Family Wealth Planning Session. What is the most important thing to make sure we talk about?
Please use this space to provide additional information on any assets or liabilities if you didn't have room on the prior pages of this form.
If there is anything else we should know as we prepare for your appointment? Let us know here.
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Affirmation
I understand that Lederman Law LLC will be supporting, advising, and empowering me to make clear choices regarding my estate plan based on the asset and debt information provided in this form. I understand that inaccurate or incomplete information could cause unintended results, including my family overlooking assets that could then end up in the state department of unclaimed property or in an undesired court process. If I formally retain Lederman Law LLC to prepare my estate plan, I will provide complete and accurate information prior to signing any estate planning documents.
I agree
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