Information Checklist

  • Information Checklist

    Kuczek & Associates 847-940-7780

  • Please fill out Information Checklist online as completely as possible and then click SUBMIT at the bottom of the form. After you press SUBMIT, you will receive an email with a copy of the Information Checklist for you to print for your records (make sure you provide an email address in the checklist).

    If you need more time to fill out the questions, go ahead and SUBMIT an incomplete form and you will receive an email with a link to go back and finish completing the form (make sure you provide an email address in the checklist and check your email / spam folder for a "confirmation of submission").

    ** Please do not PRINT this checklist using Ctrl-P or the PRINT button on your browser because additional questions will appear based on your online answers (for example - "Are you married" or "Do you have children" will prompt additional questions to appear) so it is important that you answer all questions online. **

    Please submit your Information Checklist at least 24 hours in advance of your meeting.  Otherwise, please bring a printed copy to your meeting.

    If you prefer to print and fill out the Information Checklist by hand, please click here for a PDF of the Information Checklist to print and fill out manually and bring to your meeting.

  • Date this form was filled out
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  • Birthdate
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  • US Citizen?
  • Are you married? *
  • Birthdate
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  • US Citizen?
  • Wedding Anniversary Date
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  • Do you have children?*
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Do you have additional children?
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Birthdate
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  • Grandchildren?
  • Are any of your children under 18?
  • Do you have grandchildren?
  • Do you have any deceased children?
  • Descendants?
  • Descendants?
  • Descendants?
  • Are there other people dependent on you?
  • Do you have any stored genetic material?
  • Do any of your children have stored genetic material?
  • Do you have any pets?
  • Do you want to make special provisions for your pets?
  • What documents do you have now?
  • Do any of your children have special educational, medical or physical needs?
  • Do any of your children receive SSI, SSDI, Medicaid?
  • Are any of your children adopted?
  • Have you ever made a gift exceeding the gift tax exemption?
  • Are you enrolled in the Senior Citizens Real Estate Tax Deferral Program?
  • Do you have long-term health care insurance?
  • Do you own any firearms?
  • Do you have a FOID card?
  • Does your spouse have a FOID card?
  • Have you ever been divorced?
  • Have you ever signed a pre- or post-marital agreement?
  • Have you ever inherited property from someone?
  • Do you own real estate in a state other than IL?
  • Do you want to disinherit anyone?
  • Do you want to contribute to charity upon death?

  • Health Care Agents - to make medical decisions for you in case you cannot do so yourself

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  • Health Care Agents - to make medical decisions for you if you cannot do so yourself

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  • Incapacity Trustees - if you were incapacitated, who would you want to pay your bills, manage your money, etc.

  • Incapacity Trustees - if you were incapacitated, who would you want to pay your bills, manage your money, etc.

  • Death Trustees - when you pass away, who would you want to pay your bills, gather your assets, and distribute your assets

  • Death Trustees - when you pass away, who would you want to pay your bills, gather your assets, and distribute your assets

  • Do you want to allow each beneficiary to be sole Trustee of their separate trust share?

  • Asset Summary

  • Liability Summary

  • Click SUBMIT to send this form to Kuczek & Associates.

    If you provided an email address in the checklist, you will receive an email with the Information Checklist to print for your records, and a link in case you want to go back and add information or make changes to the Information Checklist (check your email / spam folder for a "confirmation of submission").

  • Should be Empty: