Estate Planning Worksheet – Single

step 1

1) PERSONAL INFORMATION
Name

Email

Telephone: (H)

(O)

Address

Your name

SS #

Date of Birth

County of Residence

Are you a U. S. Citizen

Estimated Earned Income

Estimated Investment Income

Previous Marriages:

Children:
Name of Child One

Parents

Date of Birth

Telephone

Child's Spouse

Address

Child's Children (name/age)

Name of Child Two

Parents

Date of Birth

Telephone

Child's Spouse

Address

Child's Children (name/age)

Name of Child Three

Parents

Date of Birth

Telephone

Child's Spouse

Address

Child's Children (name/age)

Name of Child Four

Parents

Date of Birth

Telephone

Child's Spouse

Address

Child's Children (name/age)

Your Parents
Father

Age

Address

Is father financially dependent upon you?

Mother

Age

Address

Is mother financially dependent upon you?

step 2

2) ASSETS AND LIABILITIES
Real Estate
Address

County

Description

Fair Market Value

Mortgage Amount

How is title held?

Tax Map #(on tax bill)

Address

County

Description

Fair Market Value

Mortgage Amount

How is title held?

Tax Map #(on tax bill)

Address

County

Description

Fair Market Value

Mortgage Amount

How is title held?

Tax Map #(on tax bill)

Address

County

Description

Fair Market Value

Mortgage Amount

How is title held?

Tax Map #(on tax bill)

Your Insurance:
Company and Policy #

Owner

Beneficiary

Death Benefit

Cash Value

Loans on Policy

What type of policy is this (term, whole life, or universal policy)?

Company and Policy #

Owner

Beneficiary

Death Benefit

Cash Value

Loans on Policy

What type of policy is this (term, whole life, or universal policy)?

Company and Policy #

Owner

Beneficiary

Death Benefit

Cash Value

Loans on Policy

What type of policy is this (term, whole life, or universal policy)?

Your Retirement Plans and IRA's:
What type of plan is this (IRA, profit sharing, pension, 401(k), non-qualified deferred comp)?

Amount of Benefit

Beneficiary

What type of plan is this (IRA, profit sharing, pension, 401(k), non-qualified deferred comp)?

Amount of Benefit

Beneficiary

Your Brokerage Accounts
Brokerage Company

Account Number

Fair Market Value

How is this account titled?

Brokerage Company

Account Number

Fair Market Value

How is this account titled?

Brokerage Company

Account Number

Fair Market Value

How is this account titled?

Please describe any other stocks, bonds, or annuities that you own

Bank Accounts and Certificates of Deposit
Bank

Account or CD Number

Name on Account

Balance

Type of account

Bank

Account or CD Number

Name on Account

Balance

Type of account

Bank

Account or CD Number

Name on Account

Balance

Type of account

Bank

Account or CD Number

Name on Account

Balance

Type of account

Business Interests
Do you own any interest in any closely held business, professional practice, partnership, limited liability company or sole proprietorship?

Please describe the nature of your interest and provide your estimate of the fair market value of your interest?

If the business is incorporated is it a subchapter S Corporation?

Is there a buy-sell or business continuation agreement?

Please estimate the value of miscellaneous personal property including automobiles, boats, jewelry, antiques, art, tools, etc.

Does anyone owe you money? If so, please describe the nature of the loan arrangement and outstanding balance.

Please list any liabilities other than real estate mortgages that are listed under Item A.

step 3

3) MISCELLANEOUS ISSUES
Do you currently have a will?

Do you currently have a revocable trust?

Do you currently have a durable power of attorney and a health care power of attorney?

Are there any life insurance policies on your life that are owned by third parties (children, trusts, or companies)?

Are you currently the beneficiary of any Trust arrangement?

Have you established a trust of any type?

Are you expecting any substantial inheritances?

Have you ever lived in a Community Property State (California, Texas, New Mexico, Arizona, Washington, Louisiana, Nevada, or Idaho)?

Have you ever made any substantial gifts (greater than $10,000 per year) or filed a gift tax return?

Have you ever signed a prenuptial agreement, a post-nuptial agreement or an elective share waiver?

Do you have any health problems that may be relevant to this estate plan?

Do you have disability income insurance? If so, please describe the amount of insurance that you carry.

Have you started a gift program for children or grandchildren?

What is the name, address and phone number of your accountant?

Do you own have joint accounts with anyone?

Are any of your beneficiaries handicapped or disabled?

Do you have long-term care insurance?