Confidential Planning Organizer
Full Legal Name
*
Age
*
Birth Date
*
-
Month
-
Day
Year
Date
Occupation (or, if retired, former occupation)
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Employer
*
Are you Married?
*
Yes
No
Date of Marriage
-
Month
-
Day
Year
Date
Number of Years
Spouse Age
*
Spouse Full Legal Name
*
Spouse Birth Date
*
-
Month
-
Day
Year
Date
Spouse Occupation (or, if retired, former occupation)
*
Spouse Email
*
example@example.com
Spouse Phone Number
*
-
Area Code
Phone Number
Spouse Employer
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have children?
*
Yes
No
Children
*
Any disabled or handicapped child and/or child receiving special needs education and/or governmental assistance?
*
Yes
No
Any predeceased children?
*
Yes
No
Please give name(s) of any children (your grandchildren) surviving any such predeceased child
Please describe why you are seeking estate planning services at this time and who you would like to benefit from your estate
Planning Priority Profile
Please rank the following planning goals from most important to least important by dragging each option.
*
Other Important Information
Do you have any of the following advisors? (Choose all that apply)
Accountant/CPA
Personal Bank and Banker
Financial Advisor
Insurance Advisor
Attorney
Accountant/CPA Name
Accountant/CPA Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accountant/CPA Phone Number
-
Area Code
Phone Number
Personal Bank & Banker Name
Personal Bank Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Bank Phone Number
-
Area Code
Phone Number
Financial Advisor Name
Financial Advisor Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Financial Advisor Phone Number
-
Area Code
Phone Number
Insurance Advisor Name
Insurance Advisor Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Insurance Advisor Phone Number
-
Area Code
Phone Number
Attorney
Attorney Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attorney Phone Number
-
Area Code
Phone Number
Do you have a child with a learning disability?
*
Yes
No
Do you have long term care insurance?
*
Yes
No
Do any of your children receive governmental support or benefits?
*
Yes
No
Do you have adopted children?
*
Yes
No
Do any of your children have special education, medical, or physical needs?
*
Yes
No
Are any of your children institutionalized?
*
Yes
No
Are you or your spouse receiving social security, disability or other governmental benefits?
*
Yes
No
Do you provide primary or other financial support to adult children or others?
*
Yes
No
Have either you or your spouse been divorced?
*
Yes
No
Other
Are you making payments pursuant to a divorce or property settlement agreement?
*
Yes
No
Have you and your spouse ever signed a pre- or post-marriage contract?
*
Yes
No
Have you or your spouse been widowed?
*
Yes
No
Please provide a federal estate tax return or state death tax return
Browse Files
Cancel
of
Have you or your spouse ever filed a federal or state gift tax returns?
*
Yes
No
Please provide your federal or state gift tax returns
Browse Files
Cancel
of
Have your or your spouse completed previous will, trust or Estate planning?
*
Yes
No
Please provide your previous will, trust or Estate planning documents.
Browse Files
Cancel
of
Have you filed for Homestead protection at the Registry of Deeds?
*
Yes
No
Are both you and your spouse United States citizens?
*
Yes
No
Are either you or your spouse a resident or a non-resident alien?
*
Yes
No
Do you or your spouse have chronic obstructive pulmonary disease (COPD)?
*
Yes
No
Inventory of Assets
Fair Market Value and Ownership
Do you own any of the following?
*
Real Property
Annuities
Pension/Profit Sharing/Stock Options/Keough
IRA’s, 401(k)’s, 403(b)’s
Bank Accounts (Savings/Checking/Money Market/CD)
Investment and Brokerage Accounts (Mutual Funds/Securities)
Individual Certified Stocks or Bonds
Valuable Personal Property (Automobiles, Jewelry, Antiques, Collections, etc.)
Real Property (Please add)
*
Annuities (Please add)
*
Pension/Profit Sharing/Stock Options/Keough (please add)
*
IRA’s, 401(k)’s, 403(b)’s (please add)
*
Bank Accounts (Savings/Checking/Money Market/CD) (please add)
*
Investment and Brokerage Accounts (Mutual Funds/Securities) (please add)
*
Individual Certified Stocks or Bonds Held (please add)
*
Valuable Personal Property (Automobiles, Jewelry, Antiques, Collections, etc.)
Estimated Value of Household and Personal Effects
Do you have Life Insurance
*
Yes
No
Life Insurance
*
Future Inheritance
Are you anticipating any inheritance in the next 5-10 years?
Yes
No
Is your spouse anticipating any inheritance in the next 5-10 years?
Yes
No
Please estimate the possible amount of inheritance for you
Please estimate the possible amount of inheritance for your spouse
Other Assets
Do you have any other assets?
*
Yes
No
Please detail any other assets
*
Other Liabilities
Do you have any other liabilities?
*
Yes
No
Please detail any other liabilities
Anticipated Liabilities
Please describe the nature of any liabilities for which you may become liable in the future, e.g. have you signed any personal guarantees, are you engaged in a business or profession that exposes you to personal liability, etc.
Is there anything else you'd like to clarify about any of your answers?
Please describe the nature of any liabilities for which you may become liable in the future, e.g. have you signed any personal guarantees, are you engaged in a business or profession that exposes you to personal liability, etc.
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