ESTATE PLANNING INFORMATION WORKSHEET--Single Person

WFB LEGAL CONSULTING
ESTATE PLANNING INFORMATION WORKSHEET

SINGLE PERSON ONLY
PERSONAL & CONFIDENTIAL
Full Name (First, Middle, and Last):
How do you sign your name (e.g., John B. Doe)?
Date of Birth:

Month Day Year
Date
Are you a U.S. citizen?
If you are not, what is your country of citizenship?
Occupation:
Title:
Work Phone:
Work Fax:
E-Mail:
example@example.com
Cell Phone:
Home Address:
City/State:
County:
Zip:
Who is your CPA/Financial Advisor?
Who is your Insurance Agent:
Who recommended you to our Firm?
Are you a CA resident?
Have you lived in Another state besides CA? If yes, when and where?
Have you been married before? If yes, how did the marriage end?
If you have been divorced, please provide a copy of the divorce decree.
Are there any obligations pursuant to a divorce (e.g., alimony or child support)? If yes, please explain:
Are you expecting an inheritance? If yes, please explain.
Have you made gifts in any year to individuals (other than a spouse), valued over the annual exclusion amount ($14,500.00)?

Have you ever filed a gift tax return? If yes, please provide a copy of each such return.
Have you declared bankruptcy? If yes, please explain.
Have you ever filed a financial statement with a financial institution? If yes, please provide a copy of each such statement.
Do you own an interest in a business? If yes, please circle the type of business and describe it below: C Corp. S Corp. Partnership LLC Sole Proprietor
Do you have a safety deposit box? If yes, where is it located.
Durable Power of Attorney: If you were sick and could not pay your bills, whom would you wish to handle your financial affairs? This should be someone you trust without question. These are usually persons living in or near your community.
Option #1 Name:
Relationship:
City and State:
Option #2 Name:
Relationship:
City and State:
Option #3 Name:
Relationship:
City and State:

Living Will and Health Care Designation: Many people do not wish their lives to be prolonged on artificial life support. If there is no chance of recovery, whom do you wish to nominate to make your health care decisions should you become incapacitated?
Option #1 Name:
Relationship:
Address:
City, State, and Zip:
Telephone:
Option #2 Name:
Relationship:
Address:
City, State, and Zip:
Telephone:
Option #3 Name:
Relationship:
Relationship:
City, State, and Zip:
Telephone:
Option #4 Name:
Relationship:
Address:
City, State, and Zip:
Telephone:
Last Will and Testament and Living Trust: Please list your children and provide the following information below. If you do not have children, please list your beneficiaries and their information here. Providing for your children/beneficiaries may be a disincentive to achieve. You may wish to distribute either there whole inheritance at a specific age or parts of their inheritance over time at different ages. IF so, please list such percentage(s) and age(s) of distribution next to each name below.
Child/Beneficiary 1 Name:
Child/Beneficiary 1 Relationship:
Child/Beneficiary 1 Address:
Child/Beneficiary 1 City, State, and Zip:
Child/Beneficiary 1 Telephone:
Child/Beneficiary 1 Date of Birth:

Month Day Year
Date
Child/Beneficiary 1 SSN:

Child/Beneficiary 2 Name:
Child/Beneficiary 2 Relationship:
Child/Beneficiary 2 Address:
Child/Beneficiary 2 City, State, and Zip:
Child/Beneficiary 2 Telephone:
Child/Beneficiary 2 Date of Birth:

Month Day Year
Date
Child/Beneficiary 2 SSN:
Child/Beneficiary 3 Name:
Child/Beneficiary 3 Relationship:
Child/Beneficiary 3 Address:
Child/Beneficiary 3 City, State, and Zip:
Child/Beneficiary 3 Telephone:
Child/Beneficiary 3 Date of Birth:

Month Day Year
Date
Child/Beneficiary 3 SSN:
Do you wish to leave your estate in equal shares to each child/beneficiary?
If one of your children/beneficiaries predeceases you, do you wish for his or her children to receive that share?
If one of your children/beneficiaries predeceases you and that child has no children, do you wish for that share to be divided equally among your other children/beneficiaries? Please state yes or no. IF no, please state to whom and at what percentage said share(s) is to go. Please also state the name, address and relationship to you for each such person or persons.
In the event you and all your children/beneficiaries are deceased, whom do you wish to name as your alternate beneficiaries? IF APPLICABLE, please list the name; address; relationship to you; and percentage of your estate you wish to leave to each.

Whom do you wish to act as your Personal Representative(s) with regard to your Power of Attorney over Assets, should you become incapacitated?
Option #1 Name:
Relationship:
Address:
City, State, and Zip:
Option #2 Name:
Relationship:
Address:
City, State, and Zip:
Option #3 Name:
Relationship:
Address:
City, State, and Zip:
If you have minor children, whom do you wish to act as the Guardian of your children if both parents are deceased? The Guardian should be someone whom you trust with their physical well being, education, care, upbringing, etc.
Option #1 Name:
Relationship:
Address:
City, State, and Zip:
Option #2 Name:
Relationship:
Address:
City, State, and Zip:
During your life, you will act as the Trustee of your trust and you will retain full control over it. If you cannot serve due to death or incapacity, you must name a Successor Trustee(s) to manage your trust. As with the Personal Representative, this individual should be good with finances and trustworthy. To this end, he or she is likely to be the same individual whom you named as Personal Representative.

Option #1 Name
Relationship:
Address:
City, State, and Zip:
Option #2 Name:
Relationship:
Address:
City, State, and Zip:
Option #3 Name:
Relationship:
Address:
City, State, and Zip:
Are there charitable organizations which you support on an annual basis? IF yes, would you like to include any of these organizations in your estate plan? IF so, please list their names, address and the percentage of your estate you wish to leave.
Have you previously executed a will or trust? IF yes, please provide a copy of any Will or Trust that is presently effective.
Please provide a copy of every real estate deed, so that we can assess what, if anything, should be done with each parcel of real estate with reference to any trust that we may establish.
Please provide a copy of your last statements from any investment houses, such as Edward Jones, etc.

	Owner and Address of Property:	Value	Mortgage Owed
1.
2.
3.
4.

3. Bank Accounts; Money Market Accounts and CD's

	Bank Accounts/ Money Markets/CDs:	Owner	Value
1.
2.
3.
4.

4. Stocks/Options/Brokerage Non-Retirement Accounts:

	Stocks; Options; Brokerage NON-Retirement Accounts :	Owner	Value
1.
2.
3.
4.

5. Business Interests:

	Business Interests:	Owner	Value
1.
2.

6. Notes Payable To You:

	Notes Payable To You:	Owner	Value

7. IRA/401K/Annuities:

8. Life Insurance:

9. Vehicles/Personal Property:

ACKNOWLEDGEMENT: I certify this is a true and correct representation of my assets as of this date.
Print Name: *
Date:

Month Day Year
Date
Should be Empty:

ESTATE PLANNING INFORMATION WORKSHEET