ESTATE PLANNING INVENTORY & ASSESSMENT

ESTATE PLANNING INVENTORY & ASSESSMENT
We must have this Inventory and Assessment returned to us to ensure that we have enough time to understand the specifics of your situation prior to our meeting.

If you have any questions or need help in completing any part of this form, please feel free to contact us and we will set up a phone conference to assist you.

DON’T WORRY ABOUT TOTAL ACCURACY – JUST DO THE BEST YOU CAN
ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL
STEP 1: BACKGROUND INFORMATION
The information you provide in this section provides us with information about you, your age, marital status, where you live, and how best to contact you.
(name most often used to title property and accounts)
(name most often used to title property and accounts)
(other names used to title property and accounts)
Prefer to be called
SS #1
SS #2
Birthplace
Citizenship US Other
Home Address
Address

Home Address

Street Address Line 2

CityState

Zip
Email
example@example.com
Cell Phone Number
Business Telephone
Employer
Position
Address

Business Address

Street Address Line 2

CityState

Zip
Business Address
It is okay to communicate with me via my E-mail address?

YesNo
Place
Place
Premarital or Marital Agreement Yes No
Type a question

YesNo
If Widowed: Date of Death

MonthDayYear
Date
If Divorced: Date of Judgment

MonthDayYear
Date
Name of Ex-Spouse
Upload any marital or divorce documents, if any.

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Are either of your parents still living?

YesNo
CHILDREN AND/OR OTHER FAMILY MEMBERS OR BENEFICIARIES
DOB
Full Legal Name
DOB
Full Legal Name
DOB
Full Legal Name
DOB

STEP 2: ASSET INFORMATION
Determine the ownership, value, and character of your assets is essential to your estate plan. The title “ownership” is important for tax and transfer matters. The “value” is needed to determine potential tax liability. The “character” is needed to assess the manner by which the asset can transfer.
INSTRUCTIONS FOR COMPLETING THE ASSET ASSESSMENT SECTION
This Asset Assessment section is designed to help you list all the property you own and what it is worth. If you do not own property under a particular heading, just leave that section blank. Under certain headings you may own more property than can be listed on this checklist. If so, use extra sheets of paper to list your additional property.
REAL PROPERTY

Any interest in real estate including your family residence, vacation home, time share, vacant land, etc.

	General Description and/or Address	Title	Market Value

FURNITURE AND PERSONAL EFFECTS
FURNITURE AND PERSONAL EFFECTS
FURNITURE AND PERSONAL EFFECTS

List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (give lump sum value for miscellaneous less separately listed valuable items)

	Miscellaneous Furniture & Household Effects (Lump Sum)	Character	Title

AUTOMOBILES, BOATS, AND RVs

For each motor vehicle, boat, RV, etc.

	General Description	Title	Loan Balance

Upload deeds or titles, if any.

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BANK & SAVINGS ACCOUNTS

Type: Checking Account “C”, Savings Account “S”, Certificates of Deposit “CD”, Money Market “MM” (IRAs and 401(k)s listed below) NOTE: If Account is in your spouse’s name for the benefit of a minor, please specify minor’s name.

	Name of Financial Institution	Type	Title

INVESTMENT ACCOUNTS, BONDS, STOCKS, AND STOCK OPTIONS

List any and all investment accounts (IA), bonds (B), stocks (S) and stock options (SO) you have an interest in. If including stock options, please indicate value of vested and unvested options separately. If held in a brokerage account, lump them together under each account.

	Name of Financial Institution	Type	Title

LIFE INSURANCE POLICIES AND ANNITUITIES
Types: Term (T), Whole Life (WL), Split Dollar (SD), Group Life (GL), Annuity (A).

Policy 1

	Insurance Company	Type	Whose Life is Insured
Policy 2
Policy 3

RETIREMENT PLANS

Pension (P), Profit Sharing (PS), H.R.10, IRA, SEP, 401K

	Plan Name	Type	Current Value	Other Pertinent Information

BUSINESS INTERESTS
General and Limited Partnerships (GL), Sole Proprietorships (SP), Privately Owned Corporations (C), Oil Interests (O), Farm and Ranch Interests (F&R)
Type of Interest
Your Ownership Interest
Name of Business
Who Holds The Interest
Name

First NameLast Name
Upload any business documents if any.

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TRUSTEE/EXECUTOR: Upon your death, who do you want to manage and distribute the assets you leave in your estate?
Client 1’s Responses
Client 2’s Responses
Initial
Choice
Trustee
Executor
Back Up
Back Up
Back Up
Back Up

*Please include name, relationship, address and phone number.

Affirmation – Please read the following and sign below:

The undersigned understands that we rely on the asset and debt information supplied by you to develop an estate plan. The undersigned also understands that inaccurate or incomplete information could negatively impact the designed estate plan. Consequently, if the Firm is retained, you will need to provide us with complete and accurate information prior to the signing of any estate planning documents.
Client 1
Signature

Clear
Date

MonthDayYear
Date
Client 2
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

ESTATE PLANNING INVENTORY & ASSESSMENT

ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL

STEP 1: BACKGROUND INFORMATION

STEP 2: ASSET INFORMATION

INSTRUCTIONS FOR COMPLETING THE ASSET ASSESSMENT SECTION

REAL PROPERTY

AUTOMOBILES, BOATS, AND RVs

BANK & SAVINGS ACCOUNTS

INVESTMENT ACCOUNTS, BONDS, STOCKS, AND STOCK OPTIONS

LIFE INSURANCE POLICIES AND ANNITUITIES

RETIREMENT PLANS

BUSINESS INTERESTS

Name of Business

Who Holds The Interest

STEP 3: NOMINATION OF POWERS

Client 1’s Responses

Initial

Financial

Agent

Client 1’s Responses

Initial

Health Care

Agent

Client 1’s Responses

Initial

Trustee

Executor