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Full Legal Name
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Full Maiden Name
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Other Names by which you are known or by which you hold property
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Former names by which you have been known
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Home Address
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If you have another address to which you would like correspondence sent, please let us know.
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Email Address
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Would you like ro receive notices from us by email?
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Home Phone Number (include area code and, if outside the United States):
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Work Phone Number:
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Mobile Phone Number:
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Fax Number:
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At which of the above numbers should we first attempt to contact you?
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Date of Birth:
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Place of Birth:
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Citizenship:
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Social Security Number:
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Have you had any previous marriages?
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If yes, how was it ended? (ie., divorce, death)
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If by death, how was your spouse's property distributed?
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Did you serve in the military?
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If you are currently married, what was the date of you marriage?
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Place of Marriage:
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As a married couple, have you ever lived in a community property state (e.g.; Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington)?
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If so, where?
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Have you entered into a pre-nuptial agreement?
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Have you entered into a post-nuptial agreement?
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If an unmarried couple, have you entered into a co-habitation agreement?
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List the full legal name, address, date of birth and social security number of each of your children.
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Is each of these children from your current marriage?
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If the answer to the previous question is no, list each child not from your current marriage.
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Were any of your children adopted?
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If your answer is yes, please state the name of each adopted child.
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For each grandchild, give their full legal name, address, date of birth, social security number and grandchild's spouse.
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Do you have any grandchildren?
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Do you have any other dependants or beneficiaries?
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If so, please give the name, address, birthdate and social security number for each:
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Do you currently have a will?
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Have you granted anyone a power of attorney?
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Are you currently acting as a trustee, executor or personal representative under someone else's will or trust?
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Do you hold a power of attorney given to you by someone else?
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Have you given any taxable gifts during your life (i.e., greater than $10,000 per person, per year ($3,000 before 1982))?
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If yes, please describe:
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Would you like to be buried or cremated?
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Are there any special instructions or religious traditions that you would like to have followed at your funeral?
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If yes, please describe
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What was your motivation for coming to us for estate planning?
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What would you like to accomplish with your estate plan?
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What general provisions would you like to include in your estate planning documents?
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For each Real Estate Asset please tell us its location, current value, form of ownership (i.e., self, community property, etc,.), estimated date of acquisition and current mortgage amount.
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For each personal item (i.e., cars, furniture, boats, RV's, jewelry, etc) please tell us its current value, estimated date of acquisition and how the item is held (i.e., individually or jointly)
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Do you own any copyrights, trademarks, patents or other intellectual property?
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If so, please list each such item, its value, its acquisition date and form of ownership.
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Please list all bank accounts you own or control, including the bank name, type of account, account number and amount in account.
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Are there any bank accounts in your name as trustee for another (such as a minor child)? Yes No
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Are there any bank accounts on which you are named as a joint holder for someone else's convenience, such as an elderly parent? Yes No
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With respect to each marketable security (public company stocks, etc.) you own, describe the security (including number and type of shares), how security is held, date acquired and the cost or other basis.
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Are you entitled to receive any amounts under a profit sharing plan or pension plan?
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If yes, please describe:
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Do you have any Individual Retirement Accounts?
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If yes, for each state the owner of the account, the administrator, the type (traditional, Roth, etc.), current value, date begun and beneficiary
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Do you have any policies of life insurance?
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If yes, for each state: the life insurance company, insured's name, owner of the policy, type of insurance (term, whole life, universal), face amount and beneficiary.
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Do you expect to inherit any amounts under another person's will or trust?
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If yes, please describe:
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Do you have an ownership interest in any closely held businesses?
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If yes, please describe:
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If employed state: name of employer, your title, and your annual salary and bonuses
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Do you have a written employment contract?
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Please describe any stock options you may have.
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Please provide us with any additional information regarding you, your family, your estate planning goals or your assets that would be helpful to us in assessing your estate planning needs or helpful to your helpers in carrying out your estate plan:
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Please choose two persons whom you wish to be your personal representative and successor representative and list them with their addresses and their relationship to you in the order you wish them to serve:
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If you have any minor children, please list in order of preference the name address and relationship to you of your preferred guardian for the children.
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