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Planning Checklist


 

ESTATE PLANNING CHECKLIST

Date Received ___________

IT IS EXTREMELY IMPORTANT THAT THE FAMILY DATA AND ASSETS LISTED ON THE INVENTORY CHECKLIST ARE FULLY DISCLOSED AND ACCURATE IN ORDER FOR OUR LAW FIRM TO BE INFORMED IN ORDER TO PROVIDE YOU WITH OUR PROPER ADVICE.

FAMILY DATA

1. Name: Birth Date: SSN: ______________ Occupation: ________________ Citizenship: ______ USA ______ Other

Spouse’s Name: Birth Date: SSN: ________________ Occupation: _________________ Citizenship: ______ USA ______ Other

2. Home Address _________________________ Telephone: ________________ Street Cell: _______________________________ _________ _________________ City State Zip

3. Business Address_________________________________ Telephone: ___________________ Street ___________________________________, _________ _________________ City State Zip

4. Spouse Business____________________________________ Telephone: ___________________ Address Street ___________________________________, _________ _________________ City State Zip

5. Email Addresses

Any other state which may be considered a domicile, such as apartment or house maintained elsewhere (including summer home) or voting address in other state? If so, please provide information:

6. Do you have: A. A Will? Husband: Yes ( ) or No ( ) Please provide a copy. Wife: Yes ( ) or No ( ) Please provide a copy.

B. General Financial Power of Attorney? Husband: Yes ( ) or No ( ) Please provide a copy. Wife: Yes ( ) or No ( ) Please provide a copy.

C. Durable Power of Attorney for Health Care Decisions? Husband: Yes ( ) or No ( ) Please provide a copy. Wife: Yes ( ) or No ( ) Please provide a copy.

D. Declaration Concerning Life-Sustaining Procedures (a Living Will)? Husband: Yes ( ) or No ( ) Please provide a copy. Wife: Yes ( ) or No ( ) Please provide a copy.

7. Names and birth dates of children: PARENTS NAME BIRTH DATE (H, W, J)

A. __________________________ ___________ __________ B. __________________________ ___________ ___________ C. __________________________ ___________ ___________ D. __________________________ ___________ ___________

8. Advisors:

A. Attorney: _________________________ Address: _____________________________ Telephone: _______________________ _____________________________

B. Accountant: _______________________ Address: _____________________________ Telephone: ________________________ _____________________________

C. Insurance Agent: ___________________ Address: _____________________________ Telephone: ________________________ _____________________________

D. Bank: _________________________ Address: _____________________________ Telephone: _______________________ _____________________________ Safe Deposit Box: _________________

9. Special Family Information:

A. Previous marriages and commitments therefrom (attach a copy of decree and settlement papers) _________________________________________________________________________

B. Prenuptial Agreements (Attach copy)

10. Life Insurance

A. Company name: Policy # Owner (H or W) ____ Insured (H or W) Death benefit $ Cash value $

Beneficiaries: 1st 2nd

B. Company name: Policy # Owner (H or W) ____Insured (H or W) Death benefit $ Cash value $ Beneficiaries: 1st 2nd C. Company name: Policy # Owner (H or W) ____ Insured (H or W) Death benefit $ Cash value $ Beneficiaries: 1st 2nd D. Company name Policy # Owner (H or W) ____ Insured (H or W) Death benefit $ Cash value $_______________ Beneficiaries: 1st 2nd

11. Do you have any frozen sperm, eggs or embryos? Husband: Yes ( ) or No ( ) Wife: Yes ( ) or No ( )

INVENTORY CHECKLIST (USE FAIR-MARKET VALUE OF ASSETS) (Round to nearest $100.00 or $1,000.00)

HIS HER JOINT TENANTS NAME NAME TENANTS COMMON REAL ESTATE A. Homestead $____________ $____________ $___________ $ ___________

B. Ag Land Acres ________ County: ____________ ____________ ____________ ___________ ___________

C. Commercial Property Address: ______________ ____________ ____________ ___________ ___________

D. Rental Property ____________ ____________ ___________ ___________ Address: ______________

E. Vacant Lots ____________ ____________ ___________ ___________

F. Other -- out-of state ____________ ____________ ___________ ___________ Property_______________

PERSONAL PROPERTY

A. Cash $___________ $___________ $___________ $___________

B. Checking Accounts ____________ ____________ ___________ ___________ List bank name & account numbers on separate page

C. Savings Accounts ____________ ____________ ___________ ___________ List bank name & account numbers on separate page

D. Certificates of Deposit ____________ ____________ ___________ ___________ List bank name & account numbers on separate page

INVENTORY CHECKLIST

HIS HER JOINT TENANTS NAME NAME TENANTS COMMON

E. Bonds/Notes(face amount) List Issuer & Denominations of on separate page

(1) Government ____________ ____________ ___________ ___________

(2) Municipal ____________ ____________ ___________ ___________

(3) Corporate ____________ ____________ ___________ ___________

F. Stocks (1)Held in Certificate Form List Company & # of shrs. on separate page ____________ ____________ ___________ ___________

(2) Held in Brokerage ____________ ____________ ___________ ___________ (attach a copy of most recent statement)

G. Mutual Funds ____________ ___________ ____________ (attach a copy of most recent statement)

H. Non-Qualified Annuities (not part of a retirement acct.) ____________ ____________ List company name, policy number and beneficiaries on separate page

I. Retirement Funds

(1) Traditional IRA ____________ _____________

(2) Roth IRA

____________ _____________

(3) 401(K) _

___________ ______________

Name of Company

(4) Pension(s) ____________ ______________

(5) Profit sharing plans ____________ _____________

(6) Qualified Annuities ____________ _____________

(7) Other Retirement Benefits ____________ _____________

List beneficiaries of each retirement fund on separate page.

INVENTORY CHECKLIST

HIS HER JOINT TENANTS NAME NAME TENANTS COMMON

J. Business Interests; LLP, LLC, Corp., Partnership or Sole Proprietership

(1) Cash $____________ $____________ $__________ $___________

(2) Accounts Receivable ____________ ____________ ___________ ___________

(3) Inventory ____________ ____________ ___________ ___________

(4) Equipment ____________ ____________ ___________ ___________

(5) Fixtures ____________ ____________ ___________ ___________

(6) Goodwill ____________ ____________ ___________ ___________

K. Promissory Note/Contract Receivable ____________ ____________ ___________ ___________

L. Farm Personal Property

(1) Machinery & Equipment ____________ ____________ ___________ ___________

(2) Livestock & Poultry ____________ ____________ ___________ ___________

(3) Growing Crops ____________ ____________ ___________ __________

(4) Grain in storage ____________ ____________ ___________ ___________

M. Miscellaneous

(1) Jewelry, art objects, collections, furs, heirlooms, etc. ____________ ____________ ___________

(2) Cars, boats, etc. ____________ ____________ ___________

(3) Furniture & Appliances ____________ ____________ ___________

N. Anticipated Inheritance Within One Year ____________ ____________

O. Other Assets - list:

(1) _________________ ____________ ____________ ___________ ___________

(2) _________________ ____________ ____________ ___________ ___________

P. Life Insurance

(1) Permanent ____________ ____________

(2) Term ____________ ____________

(3) Group Term ____________ ____________

INVENTORY CHECKLIST

HIS HER JOINT TENANTS NAME NAME TENANTS COMMON

LIABILITIES A. Mortgage on home ____________ ____________ ___________ ___________

B. Mortgage on Rental or Commercial Property ____________ ____________ ___________ ___________

C. R.E. Contract Payable ____________ ____________ ___________ ___________

D. Current Bills ____________ ____________ ___________ ___________

E. Others Debts ____________ ____________ ___________ ___________