Estate Planning Worksheet Single Fill Out Our Estate Planning Worksheet Today Estate Planning Worksheet Single Step 1 of 12 8% Part I Personal Information Client’s Full Legal Name (name most often used to title property and accounts) Also Known As (other names used to title property and accounts) Prefer to be called Birth Date MM slash DD slash YYYY SS# US Citizen ? Home Address City State Zip Home TelephoneCounty of Residence Business TelephoneEmployer Position Business Address City State Zip E-mail Address It is okay to communicate with me via my E-mail address. Divorced Widowed Single Children and Other Family Members Use full legal name: Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments :Name Birth Date MM slash DD slash YYYY Relationship Comments : Advisors Name TelephonePersonal Attorney TelephoneAccountant TelephoneFinancial Advisor TelephoneLife Insurance Agent Telephone Your Concerns Please rate the following as to how important they are to you: (H high concern, S some concerned, L low concern, N/A no concern or not applicable) Description Level of Concern Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.Level of Concern Providing for and protecting children.Level of Concern Providing for and protecting grandchildren.Level of Concern Disinheriting a family member.Level of Concern Providing for charities at the time of death.Level of Concern Plan for the transfer and survival of a family business.Level of Concern Avoiding or reducing your estate taxes.Level of Concern Avoiding probate.Level of Concern Reduce administration costs at time of your death.Level of Concern Avoiding a conservatorship (“living probate”) in case of a disability.Level of Concern Avoiding will contests or other disputes upon death.Level of Concern Protecting assets from lawsuits or creditors.Level of Concern Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.Level of Concern Plan for a child with disabilities or special needs, such as medical or learning disabilities.Level of Concern Protecting children’s inheritance from the possibility of failed marriages.Level of Concern Provide that your death shall not be unnecessarily prolonged by artificial means or measures.Level of Concern Other Concerns (Please list below): Important Family Questions (Please check “Yes” or “No” for your answer) Are you receiving Social Security, disability, or other governmental benefits? Describe Yes No Are you making payments pursuant to a divorce or property settlement order? Please furnish a copy Yes No Have you been widowed? If a federal estate tax return or a state death tax return was filed, please furnish a copy Yes No Have you ever filed federal or state gift tax returns? Please furnish copies of these returns Yes No Have completed previous will, trust, or estate planning? Please furnish copies of these documents Yes No Do you support any charitable organizations now that you wish to make provisions for at the time of your death? If so, please explain below. Yes No Are there any other charitable organizations you wish to make provisions for at the time of your death? If so, please explain below. Yes No Are you currently the beneficiary of anyone else’s trust? If so, please explain below. Yes No Do any of your children have special educational, medical, or physical needs? Yes No Do any of your children receive governmental support or benefits? Yes No Do you provide primary or other major financial support to adult children or others? Yes No Additional Information Part II Property Information Instructions for Completing the Property Information checklist : General Headings This Property Information checklist is to help you list all the property you own and what it is worth. You probably won’t own property under all the headings; if not, just leave those blank. Under certain headings you may own more property than can be listed on this checklist. If so, attach extra sheets of paper to list your additional property. Type Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading. “Owner” of Property How you own your property is extremely important for purposes of properly designing and implementing your estate plan. For each property, please indicate how the property is titled using the following abbreviations : Owner of Property Use If own property in your name only I Joint Tenancy with someone other than a spouse, i.e. a child, parent, etc. JTO If you cannot determine how the property is owned ? Real Property TYPE: Any interest in real estate including your family residence, vacation home, time share, vacant land, etc.General Description and/or AddressOwner Market ValueLoan BalanceGeneral Description and/or AddressOwner Market ValueLoan BalanceGeneral Description and/or AddressOwner Market ValueLoan Balance TotalTotal Market ValueTotal Loan Balance Furniture and Personal Effects TYPE: List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (indicate type below and give a lump sum value for miscellaneous, less valuable items.).Type or DescriptionOwner Market ValueType or DescriptionOwner Market ValueType or DescriptionOwner Market ValueType or DescriptionOwner Market ValueType or DescriptionOwner Market ValueType or DescriptionOwner Market Value Total Total Market Value Automobiles, Boats, and RVs TYPE: For each motor vehicle, boat, RV, etc. please list the following: description, how titled, market value and encumbrance: Bank Accounts TYPE : Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s hereName of Institution and account number Type Owner AmountName of Institution and account number Type Owner AmountName of Institution and account number Type Owner AmountName of Institution and account number Type Owner AmountName of Institution and account number Type Owner AmountName of Institution and account number Type Owner Amount TotalTotal Amount Note: If Account is in your name (or your spouse’s name) for the benefit of a minor, please specify and give minor’s name. Stocks and Bonds TYPE: List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. (indicate type below)Stocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner AmountStocks, Bonds or Investment Accounts Type Acct. NumberOwner Amount TotalTotal AmountLife Insurance Policies and AnnuitiesTYPE: Term, whole life, split dollar, group life, annuity.ADDITIONAL INFORMATION: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.TotalRetirement PlansTYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K). ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.Total Business InterestsTYPE: General and Limited Partnerships, Sole Proprietorships, privately owned corporations, professional corporations, oil interests, farm and ranch interests.ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.TotalMoney Owed to YouTYPE: Mortgages or promissory notes payable to you, or other moneys owed to you.Name of Debtor Date Of Note MM slash DD slash YYYY Maturity Date MM slash DD slash YYYY Owed To Current BalanceName of Debtor Date Of Note MM slash DD slash YYYY Maturity Date MM slash DD slash YYYY Owed To Current BalanceName of Debtor Date Of Note MM slash DD slash YYYY Maturity Date MM slash DD slash YYYY Owed To Current BalanceName of Debtor Date Of Note MM slash DD slash YYYY Maturity Date MM slash DD slash YYYY Owed To Current BalanceTotalTotal Current BalanceAnticipated Inheritance, Gift, or Lawsuit JudgmentTYPE: Gifts or inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.DescriptionTotal estimated valueOther Assets TYPE : Other property is any property that you have that does not fit into any listed category.Type Owner ValueType Owner ValueType Owner ValueType Owner ValueType Owner ValueTotalTotal Value Summary of ValuesAssetsReal PropertyClientAmount*Other’sAmount*Total ValueAmount*Furniture and Personal EffectsClientAmount*Other’sAmount*Total ValueAmount*Automobiles, Boats and RV’sClientAmount*Other’sAmount*Total ValueAmount*Bank and Savings AccountsClientAmount*Other’sAmount*Total ValueAmount*Life Insurance and AnnuitiesClientAmount*Other’sAmount*Total ValueAmount*Retirement PlansClientAmount*Other’sAmount*Total ValueAmount*Business InterestsClientAmount*Other’sAmount*Total ValueAmount*Money owed to youClientAmount*Other’sAmount*Total ValueAmount*Anticipated Inheritance, Etc.ClientAmount*Other’sAmount*Total ValueAmount*Other AssetsClientAmount*Other’sAmount*Total ValueAmount*Total Assets:ClientAmount*Other’sAmount*Total ValueAmount**Values for property owned with other put your percentage in client’s column and other’s percentage in other’s column. Part III Design InformationPERSONS TO ACT FOR YOU:GUARDIAN FOR MINOR CHILDREN: If you have any children under the age of 18, list in order of preference who you wish to be guardian.Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship INITIAL TRUSTEE(S): Usually you will be the Trustee of your own trust. Allows you to control all of your assets as before.Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship DISABILITY TRUSTEE: If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your property and assets?Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship DEATH TRUSTEE: After your death, who do you want carrying out your instructions, for distribution to and, if desired, management of property for your beneficiaries?Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship Name and Address Name Address City State / Province / Region ZIP / Postal Code Relationship POWER OF ATTORNEY: If you were unable to make financial decisions for yourself, who would you want to make those decisions for you?Name Relationship Instructions or Guidelines Name Relationship Instructions or Guidelines Name Relationship Instructions or Guidelines Name Relationship Instructions or Guidelines Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated? Yes No Gifting Power Details: LIVING WILL:Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?Do you want to provide that your organs and tissues should be made available for transplant purposes?HEALTH CARE:If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?Name Relationship Instructions or Guidelines Name Relationship Instructions or Guidelines Name Relationship Instructions or Guidelines Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home?Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home? Yes No Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission? Yes No In making distributions during any period of time the client is incapacitated, the successor Trustee shall give primary consideration to: Your needs and then the needs of others dependent upon you. Your needs and the needs of others dependent upon you equally. DISTRIBUTIONS OF PERSONAL PROPERTY AND SPECIFIC GIFTSUSE OF PERSONAL PROPERTY MEMORANDUM: Do you want to provide that your personal property will be distributed pursuant to a written list you may prepare later? Yes No Any property not listed on the memorandum should be distributed to: Children equally. To the balance of the trust. Other named individuals. List on next line. SPECIFIC GIFTS: List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities.Individual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or PropertyIndividual or Charity Amount or Property DIVISION OF BALANCE OF MY PROPERTY UPON MY DEATH DIVIDE EQUALLY BETWEEN MY CHILDREN AND THE DESCENDANTS OF ANY DECEASED CHILDREN DIVIDE AMONG NAMED INDIVIDUALS and/or CHARITIES HOW AND WHEN TO DISTRIBUTE MY PROPERTY: DISTRIBUTE OUTRIGHT TO MY BENEFICIARIES: Provides no protection from creditors, predators, or from themselves. STRUCTURED TRUST: You determine how long the property is to remain in trust. During the period of time the property is held in trust it is available to the beneficiary for needs (health, education and maintenance). You may give written instructions to the trustee outlining guidelines to be followed in determining the beneficiary’s needs. You may provide for a staggered distribution of principal; i.e. 1/3 at age 30 and balance at age 40. You decide who will manage the property and to carry out your distribution instructions. Does the beneficiary have a right to be a cotrustee and/or choose his or her own cotrustee? You decide how the trust is designed. List your desires REMOTE CONTINGENT BENEFICIARY: Who do you want to receive your property in the remote event that no one listed above is alive to receive your property. Determining the remote contingent beneficiary is not so important that it should cause you to delay completion of your entire estate plan. It can always be changed at a later date.In the remote event no one listed above is alive to receive my property I want my property distributed as follows : To my heirs-at-law. To the following named individuals and/or charities OTHER ITEMS TO INCLUDE OR DISCUSS: Your estate plan should address all of your hopes, fears, and wishes. Please list any other items you want included or want to discuss : Δ
