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Husband/Spouse #1 Legal Name: |
Husband/Spouse #1 Date of Birth: |
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Wife/Spouse #2 Legal Name: |
Wife/Spouse #2 Date of Birth: |
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Address/County: |
Home Telephone Number: |
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Husband/Spouse #1 Cell Phone Number: |
Wife/Spouse #2 Cell Phone Number: |
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E-mail Address: |
Does Husband/Spouse #1 have prior marriage(s)? If so, how terminated (death/divorce)? |
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Does Wife/Spouse #2 have prior marriage(s)? If so, how terminated (death/divorce)? |
List children of this marriage and dates of birth: |
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List children from Husband/Spouse #1 prior marriage(s) & dates of birth: |
List children from Wife/Spouse #2 prior marriage(s) & dates of birth: |
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Should all children be treated as though they were children of this marriage? |
If not, would Husband/Spouse #1 like to make any distribution to his/her children from prior marriage(s)? |
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If not, would Wife/Spouse #2 like to make any distribution to
her/his children from prior marriage(s)? |
Are there any deceased children? If yes, please provide names. If yes, is he/she survived by his/her own children? |
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Are there any adopted children? If yes, please provide names: |
Do any of your beneficiaries have a learning disability, special educational, medical or physical needs? |
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Do you think any of your beneficiaries have special problems with
spouses, drugs, alcohol or handling money? |
Do you have any relatives (other than children) who depend on you for all or part of their support? |
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Do you wish to disinherit any of your children, grandchildren, or
any other close relative? |
In general, state how Husband/Spouse #1 wants his/her estate distributed among his/her beneficiaries: |
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In general, state how Wife/Spouse #2 wants his/her estate distributed
among her/his beneficiaries: |
Do you want assets passing to your beneficiaries to be held in trust until a specific age or ages, or do you want assets distributed immediately? (Note that assets held in trust may/will be used for your beneficiaries' care and welfare prior to the distribution age you choose.) |
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If you want assets held in trust, at what age(s) would you like your beneficiaries to have the assets with "no strings attached"? |
The name and address of the person(s) who you want to raise your child(ren) that are under 18, if both spouses die (the "Guardian"). Add alternate, if desired. Please provide the name and address of the person(s) you choose. |
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Would you like the Guardian to be the Trustee of any trust created, or would you like to appoint someone else to "hold the purse strings"? If you would like a different Trustee, please provide the name and address of the person(s) you choose. Add alternate, if desired. |
State any specific concerns (not already mentioned) that you have regarding the distribution of your estate: |
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The name of the person(s), other than the surviving spouse, that Husband/Spouse #1 wants to be the decision-maker concerning his/her estate upon his/her death (the "Executor"). Add alternate, if desired. |
The name of the person(s), other than the surviving spouse, that Wife/Spouse #2 wants to be the decision-maker concerning her/his estate upon her/his death (the "Executor"). Add alternate, if desired. |
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Do you both wish to have a Living Will and/or a Health Care Proxy, which will state your wishes regarding the continuance of life-support systems and appoint someone to make medical decisions on your behalf if you are unable to communicate your wishes? |
If yes, who would Husband/Spouse #1 want to make medical decisions on his/her behalf? Add alternate, if desired. Include name, address, and telephone number of of the person(s) you choose. |
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If yes, who would Wife/Spouse #2 want to make medical decisions on his/her behalf? Add alternate, if desired. Include name, address, and telephone number of the person(s) you choose. |
Do you both wish to have a Durable Power of Attorney, which would allow someone to make financial and property decisions for you in the event you are unable to do so? |
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If yes, who would Husband/Spouse #1 want to make financial decisions on his/her behalf? Add alternate, if desired. Include name, address, and telephone number of the person(s) you choose. |
If yes, who would Wife/Spouse #2 want to make financial decisions on her/his behalf? Add alternate, if desired. Include name, address, and telephone number of the person(s) you choose |
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Any family-owned businesses? |
Do either of you expect to inherit substantial assets ($100,000+)? |
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Do you have existing Wills? |
Do you have existing Trusts? |
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ESTIMATED VALUE OF ESTATE |
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Please fill in the estimated values of the assets and liabilities listed below. Please indicate if assets are owned by Husband/Spouse #1, Wife/Spouse #2, or Jointly-owned. |
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Real Estate (Fair market value of all properties) |
Securities (stocks, bonds, mutual funds) |
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Cash Type Assets (cash, bank accounts, CDs, money markets) |
Business Interests (sole proprietorship, LLC, partnership, etc.) |
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Retirement Plans (pension, IRAs, 401k, etc.) |
Vehicles (autos, boats, R.V.) |
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Personal Property (jewelry, furniture, antiques) |
Other Assets: |
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TOTAL ASSETS |
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LIABILITIES |
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Please fill in estimated liability amounts below. Indicate whether liability is Husband's/Spouse #1, Wife's/Spouse #2, or Joint. |
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Real Estate Mortgages: |
Vehicle Loans: |
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Student/Personal Loans: |
Credit Card Balances: |
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Business Debts: |
Other Debts: |
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TOTAL LIABILITIES |
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TOTAL ESTIMATED NET WORTH |
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(Subtract Total Liabilities from Total Assets) |
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LIFE INSURANCE |
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Please name the insured, cash value, face value ($ paid on death), and the beneficiaries of each policy. (Life insurance proceeds are included in your estate for Estate Tax purposes.) |
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Life Insurance Policy 1: |
Life Insurance Policy 2: |
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Life Insurance Policy 3: |
Life Insurance Policy 4: |
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TOTAL ESTIMATED GROSS ESTATE |
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(Add Total Net Worth plus Life Insurance Face Values) |
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Please make any additional comments here, or feel free to call or e-mail me with any questions or concerns you may have. |
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I will review your intake form and contact you to schedule a time when we can discuss your estate planning goals.
Thank you. |
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