Family Information & Planning Assumptions Questionnaire

Family Information & Planning Assumptions Questionnaire
Please complete the following form as best you can.
Note, all information submitted in this form is highly confidential.

If you have any questions, please feel free
to call: 913-543-3836 or email: contact@wallastreet.com
Name

First NameLast Name
Email
example@example.com
Family Information: Advisors
Advisor #1 Type of Advisor:
(Accountant, attorney, etc.)
Advisor #1 Full Name:
Advisor #1 Company Name:
Advisor #1 Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Advisor #1 Company Phone:

Area CodePhone Number
Advisor #1 Mobile Phone:

Area CodePhone Number
Advisor #1 Company Fax:

Area CodePhone Number
Advisor #1 Email Address:
Advisor #2 Type of Advisor:
(Accountant, attorney, etc.)
Advisor #2 Full Name:
Advisor #2 Company Name:
Advisor #2 Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Advisor #2 Company Phone:

Area CodePhone Number
Advisor #2 Mobile Phone:

Area CodePhone Number
Advisor #2 Company Fax:

Area CodePhone Number
Advisor #2 Email Address:
Advisor #3 Type of Advisor:
(Accountant, attorney, etc.)
Advisor #3 Full Name:
Advisor #3 Company Name:
Advisor #3 Company Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Advisor #3 Company Phone:

Area CodePhone Number
Advisor #3 Mobile Phone:

Area CodePhone Number
Advisor #3 Company Fax:

Area CodePhone Number
Advisor #3 Email Address:
Additional Notes:
Family Information: Entities
What is an entity?
An entity is a person other than a spouse, child, or grandchild that you want to include in your planning process.
Entity #1 Full Name:
Entity #1 Date of Birth:

MonthDayYear
Date
Entity #1 Gender:

MaleFemale
Entity #1 Marital Status:

U.S. CitizenResident AlienNon-Resident AlienOther
Entity #1 Relationship:
Entity #1 Skip Person?:

YesNo
Entity #2 Full Name:
Entity #2 Date of Birth:

MonthDayYear
Date
Entity #2 Gender:

MaleFemale
Entity #2 Marital Status:

U.S. CitizenResident AlienNon-Resident AlienOther
Entity #2 Relationship:
Entity #2 Skip Person?:

YesNo
Entity #3 Full Name:
Entity #3 Date of Birth:

MonthDayYear
Date
Entity #3 Gender:

MaleFemale
Entity #3 Marital Status:

U.S. CitizenResident AlienNon-Resident AlienOther
Entity #3 Relationship:
Entity #3 Skip Person?:

YesNo
Additional Entities Notes:
Family Information: Non-Profit Organizations
Non-Profit #1 Organization Name:
Non-Profit #2 Organization Name:
Non-Profit #3 Organization Name:
Non-Profit #4 Organization Name:
Additional Notes:
Planning Assumptions: Retirement & Death
Client Semi-Retirement Age:
Semi-retirement means you are employed only on a part-time basis.
Spouse Semi-Retirement Age:
Semi-retirement means you are employed only on a part-time basis.
Client Advanced Age:
Advanced age is the age at which assisted living may be necessary.
Spouse Advanced Age:
Advanced age is the age at which assisted living may be necessary.
Client Assumed age of Death:
Spouse Assumed age of Death:
Planning Assumptions: Intestacy
Is State of Residence a Community Property State?:

YesNo
Percent of Estate to Spouse:
1st Dollar Amount of Estate to Spouse:
Percent of Community Property to Spouse:
Planning Assumptions: Past Gifting
Client Taxable Gifts (after 1976):
Spouse Taxable Gifts (after 1976):
Client Federal Gift Tax Paid (after 1976):
Spouse Federal Gift Tax Paid (after 1976):
Client GST Exemption Used:
Spouse GST Exemption Used:
Should be Empty: