Estate Planning Worksheet

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Attorneys and Counselors at Law

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ESTATE PLANNING INFORMATION PACKET

(PLEASE COMPLETE THIS PACKET IN INK)

We must have this Information Packet returned to us at least three days prior to our meeting

(this will ensure we have enough time to understand the specifics of your situation before our meeting). If you need assistance completing the information, call our office (662-890-5460)

DON’T WORRY ABOUT TOTAL ACCURACY - JUST DO THE BEST YOU CAN

WE LOOK FORWARD TO SEEING YOU!!!

ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.

PERSONAL INFORMATION

Client’s Signature Name ________________________________________________________________

(Name most often used to title property and accounts)

Also Known As _____________________________________________________________________

(Legal name and other names used to title property and accounts)

Prefer to be called ____________________Birth date ___________ SS#___________ US Citizen? ____

Home Address __________________ _________ City ____________State ________Zip ___________

County_____________ Mailing Address___________________________________________________

Home Telephone _____________ Cell Phone ________________ Business Telephone _____________

Occupation _____________________________________ Employer ____________________________

Business Address _____________________ ________ City ____________State ________Zip________

E-mail Address ______________________________ It is okay to communicate with me via E-mail.

Married: Date__________ Divorced: Date__________ Widowed: Date___________ Single

Cohabiting: Domestic Partnership Registration Filed?

Partner’s Signature Name __________________________________________________________

(Name most often used to title property and accounts)

Also Known As _____________________________________________________________________

(Legal name and other names used to title property and accounts)

Prefer to be called ____________________Birth date ___________ SS#___________ US Citizen? ____

Home Address __________________ _________ City ____________State ________Zip ___________

County_____________ Mailing Address___________________________________________________

Home Telephone _____________ Cell Phone ________________ Business Telephone _____________

Occupation _____________________________________ Employer ____________________________

Business Address _____________________ ________ City ____________State ________Zip________

E-mail Address ______________________________ It is okay to communicate with me via E-mail.

Married: Date__________ Divorced: Date__________ Widowed: Date___________ Single

Cohabiting: Domestic Partnership Registration Filed?

CHILDREN AND OTHER BENEFICIARIES

Please use full legal names, make note if deceased.

CHILDREN OF THIS MARRIAGE/PARTNERSHIP: □ None AGE or DOB

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

NON-MARITAL OR ADOPTED CHILDREN: □ None Client Partner DOB

__________________________________________ □ □ ____

__________________________________________ □ □ ____

__________________________________________ □ □ ____

__________________________________________ □ □ ____

__________________________________________ □ □ ____

Treat all children as if they were the children of this marriage? □ No □ Yes

OTHER BENEFICIARIES: □ None AGE or DOB

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

__________________________________________ ________________

ADVISORS

Name Telephone

Accountant _______________________________________________ ______________

Financial Advisor _______________________________________________ ______________

Life Insurance Agent _______________________________________________ _____________

YOUR PLANNING OBJECTIVES

Please identify the reasons you are considering planning or areas you would like to learn more about (select as many as you wish):

Preserve and Maximize Assets

By minimizing taxes during your life (income taxes, capital gains taxes, estate taxes on inheritances you expect to receive)

By minimizing or eliminating estate taxes upon your death (up to 55% of your assets and life insurance benefits)

By reducing estate administration costs through probate avoidance

Avoid or limit MediCal claims on your assets should you require long-term care

Ensure that a special needs beneficiary has assets that are protected from government seizure while retaining eligibility for needed services

Ensure that your family has enough life insurance to provide a comfortable lifestyle no matter what

By ensuring that your assets are passed to your descendants and not given away to outsiders, such as spouses, creditors or the government

Protect Yourself and Your Spouse

From malpractice or other creditor claims

From conservatorship proceedings (aka”living probate”) if you or your partner become incapacitated

From probate delays and stress upon your death or the death of your partner

From hospital policies requiring life sustaining procedures when you would rather not endure them

From healthcare decisions made by people other than those you trust most

Protect Your Children or other Beneficiaries….

From predators who can discover inheritance amounts and target young or vulnerable beneficiaries

From claims of divorced spouses to take half of your child or beneficiary’s inheritance

From malpractice claims, for beneficiaries in the professions

From other creditors’ claims (such as car accident plaintiffs)

From the stress and delays of the average 16-month process of probate

From the financial immaturity resulting in a quick loss of an inheritance

From sharing assets with heirs you would rather disinherit

From litigation claims by disinherited heirs

For parents only: from relatives who would be poor, abusive or even dangerous guardians or from foster care

For parents only: from acquaintances, relatives and others who should not be allowed to be alone with your children

For special needs beneficiary only: from neglect in the government care system

Achieve your Dreams

Have clarity about your life purpose, goals and dreams

Benefit a charitable organization or activity

Support a common family goal through coordinated planning

For parents only: By providing guidelines for how your children should be supported while their assets are in trust.

For special needs beneficiaries only: By providing instructions, personnel, and assets to support your special needs beneficiaries above a poverty lifestyle

For business owners only: By providing for the orderly continuation and transfer of family business interests rather than a distress sale

IMPORTANT FAMILY QUESTIONS
	CLIENT				PARTNER
Do you have a will, trust, or other estate planningdocument? Please furnish copies of these documents	Yes		No		Yes	No
Are you making payments pursuant to a divorce orproperty settlement order? Please furnish a copy	Yes		No		Yes	No
If married have you and your spouse signed a pre- orPost-marriage contract? Please furnish a copy	Yes		No		Yes	No
Do you or any of your children or other beneficiarieshave disabilities, serious health problems or other special needs? If yes, please describe below	Yes	No		Yes		No
Do you own a business?	Yes		No		Yes	No
Do you own a long-term care (nursing home) insurance policy?	Yes		No		Yes	No
Do you own any property that is not community property?	Yes		No		Yes	No
Have you (or has your spouse) ever filed federal or state gift tax returns? Please furnish copies of these returns.	Yes		No		Yes	No
Do you support any charitable organizations now thatAre wish to make provisions for at time of your death?If so, please explain below.	Yes		No		Yes	No
Are you (or your spouse) currently the beneficiary of anyone else’s trust? If so, please explain below.	Yes		No		Yes	No

ADDITIONAL INFORMATION FROM ABOVE OR ANYTHING ELSE YOU WANT TO TELL ME.

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FAMILY VALUES

Rate the following values in order of their importance to your from “Most Important” to Least Important.” Feel free to leave blank an item you do not wish to rank.

Most Least

Important Important Netural Important

§ Cultural values such as art, music, travel.

§ Economic values such as financial responsibility,

frugality, savings.

§ Educational values such as study, self-improvement,

academic achievements, lifelong learning.

§ Emotional values such as compassion, kindness,

generosity.

§ Ethical values such as honesty, fairness, justice.

§ Material values such as possessions, social standing,

rank and title.

§ Personal values such as modesty, loyalty,

independence.

§ Philanthropic values such volunteer work,

donations (time and money).

§ Physical values such as health, relaxation,

exercise, appearance.

§ Public values such as citizenship,

community involvement, public service.

§ Recreational values such as sports,

leisure time, hobbies, vacations.

§ Relationship values such as family,

friends, colleagues.

§ Spiritual values such as faith, belief in

God, inner peace.

§ Work values such as effort, competence,

professional recognition and success.

INCOME/ASSET/LIABILITY INFORMATION

Please list your income/asset/liability information in the appropriate section below.

Attach additional pages, if necessary.

INCOME: Client Community/Joint Partner

Earned Monthly Income from ___________ ___________ ___________

Labor:

Monthly Social Security Income: ___________ ___________ ___________

Monthly Pension Income: ___________ ___________ ___________

Other Monthly Income: ___________ ___________ ___________

ASSETS:

REAL PROPERTY

Please list any interest in real estate including your family residence, vacation home, time-share or vacant land. (please list manner in which title held - Joint Tenant, Community Property, Separate Property, Tenant in Common)

Market

General Description and/or Address Owner Value Equity

_______________________________________ ________ ________ ________

_______________________________________ ________ ________ ________

_______________________________________ ________ ________ ________

Total ________ ________

PERSONAL PROPERTY

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 lump sum value for miscellaneous, less valuable items.).

Type or Description Owner Market Value

Miscellaneous Furniture and Household Effects (Total _______ _______

_______________________________________________ _______ _______

_______________________________________________ _______ _______

_______________________________________________ _______ _______

_______________________________________________ _______ _______

Total _______

BANK & SAVINGS ACCOUNTS

IF YOU PREFER, YOU CAN WAIT UNTIL AFTER OUR MEETING TO SUPPLY ACCOUNT NUMBERS

TYPE: Checking Account “CA“, Savings Account “SA“, Certificates of Deposit “CD“, Money Market “MM” (indicate type below).

Do not include IRA’s or 401(k)’s here

Name of Institution and account number Type Owner Amount

__________________________________________ MM ________ ________

__________________________________________ MM ________ ________

__________________________________________ MM ________ ________

__________________________________________ MM ________ ________

__________________________________________ MM ________ ________

__________________________________________ MM ________ ________

Total ________

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

IF YOU PREFER, YOU CAN WAIT UNTIL AFTER OUR MEETING TO SUPPLY ACCOUNT NUMBERS

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. Number Owner Amount

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

____________________________________ ________ _____________ ________ _________

Total ________

LIFE INSURANCE POLICES AND ANNUITIES

TYPE: 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.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Total ____________________

RETIREMENT PLANS

TYPE: 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 INTERESTS

TYPE: 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.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Total __________________

MONEY OWED TO YOU

TYPE: Mortgages or promissory notes payable to you, or other moneys owed to you.

Date of Maturity Owned Current

Name of debtor Note Date to Balance

_____________________________ _________ ________________ ____________ _____________

_____________________________ _________ ________________ ____________ _____________

_____________________________ _________ ________________ ____________ _____________

_____________________________ _________ ________________ ____________ _____________

Total _____________________

ANTICIPATED INHERITANCE, GIFT, OR LAWSUIT JUDGMENT

TYPE: 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.

Description __________________________________________________________________________________________

____________________________________________________________________________________

Total estimated value________________________

OTHER ASSETS

TYPE: Other property is any property that you have that does not fit into any listed category.

Type Owner Value

____________________________________ _____________ _____________

____________________________________ _____________ _____________

____________________________________ _____________ _____________

____________________________________ _____________ _____________

____________________________________ _____________ _____________

____________________________________ _____________ _____________

Total _____________________

SUMMARY OF VALUES

Amount*

ASSETS Client Partner Total Value

Real Property _________ _________ _________

Bank and Savings Accounts _________ _________ _________

Stocks and Bonds _________ _________ _________

Life Insurance and Annuities _________ _________ _________

Retirement Plans _________ _________ _________

Business Interests _________ _________ _________

Money owed to you _________ _________ _________

Anticipated Inheritance, Etc. _________ _________ _________

Other Assets _________ _________ _________

Total Assets:

_________ _________ _________

* Joint Property values enter 1/2 ill Client’s column and 1/2 ill Partner’s column.

DESIGN INFORMATION

PERSONS TO ACT FOR YOU - IF YOU ARE UNABLE

GUARDIAN FOR MINOR CHILDREN:

If you have any children under the age of 18, list in order of preference, persons who would raise them and love them in the manner as close as possible to the way you would.

Name, Address and Phone Number Relationship

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GUARDIAN FOR PETS:

________________________________________________________________________________

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FINANCIAL DECISION MAKERS

DEATH TRUSTEE: After both of your deaths, who do you want making decisions regarding the

management and distribution of your assets to your beneficiaries?

Name, Address and Phone Number Relationship

________________________________________________________________________________

________________________________________________________________________________

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________________________________________________________________________________

________________________________________________________________________________

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HEALTH CARE DECISION MAKERS

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?

CLIENT’S AGENT

Name, Address, and Phone Number Relationship

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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?

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PARTNER’S AGENT

Name, Address, and Phone Number Relationship

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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?

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