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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?