ESTATE PLANNING WORKSHEET Information provided is held in complete confidence, and is used for the sole purpose of analyzing estate planning needs and designing estate planning documents. Preparation of this worksheet is not mandatory prior to the initial appointment with us, but if we are able to review the completed worksheet prior to your appointment, more information and value will be received during the complimentary initial consultation. WE OFFER A FREE NO-OBLIGATION, 30-MINUTE CONSULTATION During the initial consultation, we will determine your specific estate planning needs and goals. The potential cost of probate and estate tax which would occur with your current plan will be analyzed, and methods of reducing costs and accomplishing your goals will be discussed. An exact quote on fees for estate planning will be provided before you decide to authorize completion of your estate plan PREPARED BY: Law Offices of MONTY L. DONOHEW, LPA 5590 Lauby Road Ste 7 North Canton OH 44720 (330) 896-0300 877-816-8670 (Toll Free) 866-904-9638 (Telefax) www.donohew.com METRO PLACE CENTER 545 Metro South Suite 100 Dublin, OH 43017 REGUS CENTER 100 Chesterfield Business Pkwy Suite 200 Chesterfield, Missouri 63005
ESTATE PLANNING WORKSHEET The information requested on this worksheet may seem like none of our business, but it is very important that an estate planner understands your present situation and your wishes for the future. This information enables us to plan the estate to accomplish future goals and to save on taxes and administrative expenses. If you are married and all information on this worksheet is identical for you and your spouse, complete only one worksheet. If information for each spouse differs, make a copy of this worksheet so each spouse has a separate one. Unmarried couples may use the worksheet just as married couples, but please be sure to insert correct marital status as it significantly affects application of tax rules. For those of you who are single, we apologize for phrasing everything based on husband and wife. This is for simplicity of the form only. To complete this worksheet, please fill in the wife s blanks if you are female and the husband s blanks if you are male. Estate planning is very important for singles as well as couples. Plan of distribution for singles is not obvious and most or all assets will be probated since joint tenancy with a spouse is not an available method of avoiding probate. Date Phone Number First Mid.Initial Last Date of Birth Nickname or Maiden Name(s) First Mid.Initial Last Date of Birth Nickname or Maiden Name(s) Street City State Zip County Marital Status: G Married G Divorced G Separated G Single (including widowed and not remarried) MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -1-
What is your primary motivation for considering estate planning? (Select one or more) G Probate avoidance G Ease of Administration G Aging-In-Place G Oil and Gas Royalties Planning G Guardianship for minor children G Federal estate tax planning G Asset Protection Planning G Other: G Guardianship Risk Reduction G Reduce Risk of Contest G Medicaid (Nursing Home Spend-down) G Multi-generational IRA G Business or farm planning G Ohio Estate Tax Planning G Special Needs/Gov t Benefits Planning How soon would you like to complete planning? Is there a specific deadline, such as an upcoming trip, surgery, etc.? Husband Wife Do you presently have a will? G Yes G No G Yes G No Do you presently have a trust? G Yes G No G Yes G No Are you interested in avoiding probate of your estate? G Yes G No G Yes G No Were there any previous marriages? G Yes G No G Yes G No Are any of your children not from your current marriage? G Yes G No G Yes G No Do any of your children or other beneficiaries have disabilities? G Yes G No G Yes G No Do you own a farm or business? G Yes G No G Yes G No If yes, do any of your children work in the business with you? G Yes G No G Yes G No If yes, does the child working in the business have an G Yes G No G Yes G No ownership interest in the business? Are you a U.S. citizen? G Yes G No G Yes G No Have you entered into any agreements with your spouse G Yes G No G Yes G No (such as a prenuptial or community property agreement)? Do you presently have an IRA will? G Yes G No G Yes G No Has an attorney reviewed your Beneficiary Designations for Qualified Plans (IRA, 401k, SEP, TSA etc.) G Yes G No G Yes G No Are you interested in reducing income taxes? G Yes G No G Yes G No Are you interested in reducing tax on social security? G Yes G No G Yes G No Are you interested in reducing estate taxes? G Yes G No G Yes G No MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -2-
Are you concerned regarding Medicaid spend-down? G Yes G No G Yes G No Do you own rental properties? G Yes G No G Yes G No Are they in an LLC, FLP or corporation? G LLC G FLP GSCorp G CCorp Are you concerned about liability/asset protection? G Yes G No G Yes G No Are you (or your spouse) a U.S. Veteran? G Yes G No G Yes G No Did you (or your spouse) serve during wartime? G Yes G No G Yes G No Are you interested in reducing income tax on social security? G Yes G No G Yes G No Do you or any family members or potential beneficiary have any serious health problems? If yes, please describe briefly: Do any of your beneficiaries (e.g., children or grandchildren) have special or unique circumstances, risks to their inheritance, or are they unable to responsibly manage their inheritance (developmental disability, physical or mental disability; bankruptcy or receivership; abusive or domineering spouse; drug, alcohol, or non-substance addiction; member of cult or religious organization to which assets are pledged; incarcerated). If so identify beneficiary and describe the circumstance: Do you own a long-term care (nursing home) insurance policy? G Yes G No G Yes G No Do you hold everything jointly with your spouse? GAll joint (except G Some separate IRA s, pensions, etc.) NET WORTH: If you added the value of all property owned by yourself and your spouse including real estate, personal property, bank accounts, stocks, bonds, IRAs, and anything else you own except death benefits on life insurance, what is the approximate total value of the estate of yourself and your spouse? Insuring Insuring What is the value of death benefits on life insurance? Husband Wife What is the total amount of your outstanding liabilities? _ MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -3-
INCOME/ASSET/LIABILITY INFORMATION Please list your income/asset/liability information in the appropriate category below. Attach a separate page if necessary. Husband Community/Joint Wife INCOME: Earned Monthly Income Monthly Social Security Income Monthly Pension Income Other Monthly Income Are you expecting or anticipating inheritance from another person? If so, relationship, age, and amount anticipated Are you concerned about the estate or financial plan of another that might affect you, such as a parent or child. If so, relationship and why? Do you have other financial planning concerns (such as worry that assets will not meet needs, management of real estate or business, excessive taxes, etc.)? Please describe: MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -4-
Title in Which Held (Husband sole, Wife Type of Asset sole, Joint with spouse, Current Value Joint with third party, Tenants in common, etc.) REAL ESTATE (Include type of property e.g., residential, agricultural, commercial, or manufacturing) Personal Residence Vacant Land Other: LIQUID ASSETS (Include Account Number and Where Held) Cash on Hand Government and Publicly Traded Securities Unlisted Securities (Not Publicly Traded) Money Market Accounts Equity in Business Sole Prop. Partnership Corp. Notes and Loans Receivable Checking Accounts Savings Account Certificates of Deposit Automobiles Other Personal Property MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -5-
Annuities Type of Asset Title in Which Held (Husband sole, Wife sole, Joint with spouse, Joint with third party, Tenants in common, etc.) Owner Beneficiary Current Value Current Value IRAs Pension/Profit Sharing Life Insurance Cash Value Death Benefit Other Assets LIABILITIES Name Loan Taken In: Amount Owed (Husband, Wife, etc.) NOTES ON ASSETS MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -6-
Name CHILDREN OR OTHER BENEFICIARIES Address and Phone Date of Birth Child of H or W? GIFT TAX RETURNS Have gift tax returns ever been filed to report gifts made? ***If YES, please bring copies of the returns to your appointment. MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -7-
APPOINTMENTS 1. SUCCESSOR TRUSTEE. If you choose to avoid probate of your estate by executing a living trust during lifetime, a successor trustee should be named. The successor trustee would be responsible for managing assets if you were unable, or in the case of a joint trust, if neither you nor your spouse were able, to manage assets due to incompetence. The successor trustee would distribute assets to beneficiaries after death, or in a joint trust, when neither you nor your spouse survives. If you are husband and wife, please check here if you do not want your husband or wife to be Co-Trustee, and here if you do not want spouse to be first successor trustee. For married couples, then, the following should be after both deaths: SUCCESSOR TRUSTEE: ALTERNATE: SECOND ALTERNATE: THIRD ALTERNATE: 2. PERSONAL REPRESENTATIVE. The will should name a personal representative to probate the estate. (Personal representative is also sometimes referred to as executor or administrator.) (E.g., spouse as primary personal representative, with a child, relative, friend, or corporate trustee as alternate. In second marriage situations, spouse as primary personal representative may not be appropriate.) PERSONAL REPRESENTATIVE: ALTERNATE: SECOND ALTERNATE: THIRD ALTERNATE: 3. HEALTH CARE AGENT. Who should be named to make medical decisions on your behalf including decisions regarding medical consents, life support issues, and nursing home admission if you were unable to make these decisions yourself? (Frequently, the primary agent is the spouse.) It is not necessary to appoint the same person who is your successor trustee or personal representative as your health care agent. HEALTH CARE AGENT: ALTERNATE: SECOND ALTERNATE: 4. POWER OF ATTORNEY. Who should be named to make financial decisions on your behalf including decisions regarding asset control and management if you were unable to make these decisions yourself? (Frequently, the primary agent is the spouse.) It is not necessary to appoint the same person who is your successor trustee or personal representative as your health care agent. AGENT: ALTERNATE: SECOND ALTERNATE: THIRD ALTERNATE: 5. GUARDIAN. Who should be named to be your guardian and caretaker in the event that you become incapacitated and/or incompetent? It is not necessary to appoint the same person as your trustee, but keep in mind that disputes may arise between persons acting in different capacities in your best interest GUARDIAN: ALTERNATE: SECOND ALTERNATE: THIRD ALTERNATE: MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -8-
6. PERSONAL PHYSICIAN. Who should be named to make the determination whether or not you are incompetent or incapacitated? This will normally be your personal physician, although it can be a close personal friend, if they are a licensed medical doctor or osteopath. HUSBAND S DOCTOR_ ALTERNATE: WIFES S DOCTOR: ALTERNATE: PLAN OF DISTRIBUTION 1. SPECIFIC GIFTS. Do you want to make charitable gifts, such as to a house of worship or other institution? Do you wish to make a special gift to a particular person, such as a piece of jewelry to a particular child? 2. PRIMARY DISTRIBUTION. Briefly describe where you would want assets remaining after any specific gifts are distributed. (Don t worry about tax planning or other considerations in answering this question. We ll consider those details later if needed.) G All to spouse; then equally between children, and if a child didn t survive, the deceased child s children would take the share of the deceased child. G All to spouse, then equally between surviving children G All to spouse, then G As follows: 3. ULTIMATE DISTRIBUTION. You might want to provide for the distribution of your property if neither you, your spouse nor your children/other beneficiaries named above survive. If you have no plan, we will direct closest living relatives as determined by Statute of Descent. _ MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -9-
PLEASE COMPLETE THIS SECTION ONLY IF YOU HAVE MINOR BENEFICIARIES OR BENEFICIARIES WITH DISABILITIES 1. GUARDIAN. If you have minor children or a beneficiary with special needs, you may need to appoint a guardian. The guardian is responsible for the day-to-day care of the child. It is a good idea to name an alternate guardian to act if your first choice cannot serve. GUARDIAN: ALTERNATE: 2. TESTAMENTARY TRUSTEE. You may need a trustee to manage assets for beneficiaries until they reach an age when you believe they should be capable of managing assets on their own. A trustee can keep the beneficiary s money invested wisely and use it for their education, support, etc., until they reach the age specified for outright distribution of assets to them. The trustee can be a relative, friend, trust company, or other person or institution you trust to manage and distribute assets according to your wishes. The testamentary trustee can be the same person named as the guardian, or could be a different person or institution. TESTAMENTARY TRUSTEE: ALTERNATE: 3. AGE OF DISTRIBUTION. If you do establish a trust to allow a third party to manage assets for beneficiaries, then it is necessary for you to decide when the beneficiaries will be mature enough to manage assets on their own. You may want to give each beneficiary his or her share at the time the beneficiary reaches a particular age. You may consider splitting the distribution, such as ½ at age 25 and the balance at age 30, or 1/3 at 25, 1/3 at 30, and 1/3 at 35. We default to the latter. You may use any age or combination of ages that you choose. Check here if you do NOT want the trust available for education costs until then. MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -10-
GENERAL QUESTIONS NOTES AND QUESTIONS: Please note anything else which may be of importance in planning your estate, or note any questions you may have. MONTY L. DONOHEW, LP A CONFIDENTIAL PAGE -11-