ESTATE PLANNING WORKSHEET

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Crystal Perkins
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1 ESTATE PLANNING WORKSHEET Please complete the following worksheet and mail it to my office prior to our initial meeting, or it, or bring it with you. At the end of the worksheet is a list of documents I will also need. CLIENT BACKGROUND INFORMATION Name (first, middle, last) Birth date Spouse s name (first, middle, last) Birthdate Occupation: Address Spouse s Occupation Telephone: (Home) (Work) Are you and your spouse United States citizens? FAMILY INFORMATION If you or your spouse have surviving parents, are their financial resources sufficient to meet the expense of any level of health care? Children: Name Age Birthdate If any child is by a previous marriage, please indicate whether he/she is the child of you or your spouse. If a child is not living with you, please provide his/her address. FIDUCIARIES 1. Personal Representative: In order of preference, please provide the names and addresses of those whom you would like to serve as Personal Representative of your estate. The Personal Estate Planning Worksheet - Page 1

CLIENT BACKGROUND INFORMATION Name (first, middle, last) Birth date Spouse s name (first, middle, last) Birthdate Occupation: Address Spouse s Occupation Telephone: (Home) (Work) Are you and your

2 Representative is the person who, if your estate is probated, is appointed by the court to represent your estate after your death. 2. Guardians: If you have any children under the age of 18, please provide the names and addresses, in order of preference, those whom you would like to serve as their Guardians. The guardians are the persons who will raise and care for your children until they reach the age of 18 years. 3. Trustees: Please provide the names and addresses, in order of preference, those whom you would like to serve as Trustee of any trusts. Normally married couples nominate the other spouse as their Estate Planning Worksheet - Page 2

their Guardians. The guardians are the persons who will raise and care for your children until they reach the age of 18 years. 3.

3 first choice. Whomever your choose, the person selected should be reasonably skilled at managing financial matters. SPECIAL FAMILY CONSIDERATIONS Handicapped child or other beneficiary (mental or physical): Any other family concerns or issues you may have: FAMILY ADVISERS Name Address and Telephone Accountant Insurance Agent Stock Broker Estate Planning Worksheet - Page 3

4 Physician Other PROPERTY Real Estate Ownership/title Home Mortgage Recreational Mortgage Investment Mortgage Other Mortgage Financial Assets Cash savings/ checking Brokerage Accounts Business Holdings Briefly describe business: Corporation, LLC, Partnership? Best estimate of fair market value Estate Planning Worksheet - Page 4

checking Brokerage Accounts Business Holdings Briefly describe business:

5 Personal Property Household Goods Vehicles Car loans Jewelry Other Retirement Assets Inheritance Description Amount Beneficiaries Pensions IRAs 401(k)s Annuities Do you or your spouse expect to receive any inheritance within the next 10 years?. Best estimate of amount. Other assets not listed above Description Value Estate Planning Worksheet - Page 5

your spouse expect to receive any inheritance within the next 10 years?

6 LIABILITIES Personal loans Business loans Other PROPERTY DISPOSITION 1. Special Bequests: Do you wish to make any specific gifts to specific people? (Attached additional sheet if necessary) 2. General Bequests: How do you wish to distribute your estate among your family? 3. Charitable Bequests: Do you wish to make any charitable bequests? MISCELLANEOUS Estate planning concerns: Briefly list specific concerns you may have. (examples are concerns about probate, taxes, a particular child, squabbling, attorney fees, etc) Questions: You may use this space to list any questions that you want me to address. 1. Estate Planning Worksheet - Page 6

Charitable Bequests: Do you wish to make any charitable bequests? MISCELLANEOUS Estate planning concerns: Briefly list specific concerns you may have.

7 2. 3. NEEDED DOCUMENTS Please provide copies of the following documents. Existing Trust Agreements, Last Will and Testament, Prenuptial Agreements Most recent Statements of all financial accounts on which you or your spouse is an authorized signer, including savings accounts, checking accounts, brokerage accounts, mutual funds, IRAs, 401(k)s, 403(b)s, KEOGHs, pensions, and other financial accounts Bonds, stocks and other securities held directly and not through a broker Deeds to real property, Land Sale Contracts, Leases Promissory notes, mortgages, trust deeds and other evidences of debts receivable Life insurance policies Partnership agreements, buy-sell agreements Estate Planning Worksheet - Page 7

including savings accounts, checking accounts, brokerage accounts, mutual funds, IRAs, 401(k)s, 403(b)s, KEOGHs, pensions, and other financial accounts Bonds, stocks and other

Wills & Estate Planning Information requested and/or things to consider for the drafting of your Last Will & Testament

ESTATE PLANNING WORKSHEET Wills & Estate Planning Information requested and/or things to consider for the drafting of your Last Will & Testament LEGAL NAME Date of Conference ADDRESS ZIP CODE TOWNSHIP