Estate Planning - Single
First Name
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Last Name
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Date of birth
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EIN or SSN
*
Other Names (also known as):
Phone
*
Email
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Home Address, City, State, and Zip of Residence
Address
City
State
Postal code
Do you have children?
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Yes
No
List Of Children
Child Guardians
Are you a US Citizen?
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Yes
No
Immigration Information
Position/Title with Employer
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Business address
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Do you have a current Attorney?
Yes
No
Do you have an Accountant?
Yes
No
Do you have a Financial Advisor?
Yes
No
Do you have a Life Insurance Agent?
Yes
No
List of Advisors
Please check those areas/topics of concern to you
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(level of concern and in-depth discussion will be addressed at consultation):
Additional Comments
Are you receiving Social Security, disability, or other governmental benefits?
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Yes
No
Describe Social Security, disability, or other governmental benefits
Are you making payments pursuant to a divorce or property settlement order?
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Yes
No
Documents related to divorce or property settlement order?
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Have you ever been widowed?
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Yes
No
If a federal estate tax return or a state death tax return was filed, please furnish a copy.
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Have you ever filed federal or state gift tax returns?
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Yes
No
Documents related to federal or state gift tax returns
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Have you completed a previous will, trust, or estate planning?
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Yes
No
Copies of previous will, trust, or estate planning
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Do you support any charitable organizations now that you wish to make provisions for at the time of your death?
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Yes
No
Charitable Organizations and Provisions You Want Made
Are you currently the beneficiary of anyone else’s trust?
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Yes
No
Explain if you are the beneficiary of anyone else’s trust:
Do any of your children have special educational, medical, or physical needs?
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Yes
No
Explanation of children that have special educational, medical, or physical needs:
Do any of your children receive governmental support or benefits?
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Yes
No
Explain the receipt of governmental support or benefits:
Do you provide primary or other major financial support to adult children or others?
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Yes
No
Explain major financial support to adult children or others:
General description (or address) of real estate, who the Owner of this real estate is, Market Value and any Loan Balance:
General description of personal property items, who the Owner is of those items and the Market Value:
For each motor vehicle, boat, RV, etc., please list a general description of the item, how titled, Market Value and encumbrance:
For any checking accounts, please list Banking Institution, Account No., who is the Owner and estimate of Amount in each account:
For any savings accounts, please list Banking Institution, Account No., who is the Owner and estimate of Amount in each account:
Do you own any Certificates of Deposit?
Yes
No
Do you own any Money Market accounts?
Yes
No
If any of the above Accounts is in your name for the benefit of a minor, please specify and give minor’s name:
List any stocks, bonds and/or investment accounts (indicating which type), any Account No associated with them and estimate of Amount:
Please list any Life Insurance held, including Insurance company, type, face amount (death benefit), whose life is insured, the current beneficiaries, and who is the life insurance agent:
Please list any Retirement Plans, including description of the type of plan, the plan name, the current value of the plan, and any other pertinent information:
Please list any Business Interests, including a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.
Do you have any Mortgages and/or Promissory Notes payments due to you?
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Yes
No
Mortgages and Promissory Notes Debtor Information
Do you have gifts and/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?
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Yes
No
Gifts and/or inheritances details and estimated
List any other property and/or asset that does not fit into any listed category:
Please designate your Initial Trustee(s), including address(es) and relationship to you:
Please designate your Disability Trustee(s), including address(es) and relationship to you:
Please designate who you would have act as your Power of Attorney Agent(s), their relationship to you and any specific instructions/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
Financial Agent Gift Details
Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?
Yes
No
Do you want to provide for organ and/or tissue donation?
Yes
No
Please designate your Health Care Agent(s), their relationship to you and any specific instructions/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?
Yes
No
In making distributions during any period of time the client is incapacitated, the successor Trustee shall give primary consideration to:
DISTRIBUTIONS OF PERSONAL PROPERTY AND SPECIFIC GIFTS The following section designates the disposal of personal property and gifts according to your wishes.
Do you want to provide that your personal property will be distributed pursuant to a written list you may prepare later (by way of a Personal Property Memorandum)?
Yes
No
Other Named Individuals (if Any)
Any property not listed on the memorandum should be distributed to:
Do you wish to make any Specific Gifts?
Yes
No
Please list whether gift is for an individual or charity, and then if the gift is cash 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.
Named Individuals and Charities For Property
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 flow in determining the beneficiary’s needs. You may provide for a staggered distribution of principal. For example: 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:
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:
Additional Individuals and/or Charities
Other Items
What are your wishes as to the disposition of your remains?