Estate Planning Questionnaire

Download Fillable PDF Form

1Client Information

2Marital Status

3Children and Other Family

4Current Estate Planning Documents

5Advisor Contact Information

6Miscellaneous

7Property

8Your Estate Plans

Name(Required)

First Middle Last Maiden

Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Business Phone

Cell Phone

E-mail Address(Required)

WE WILL NOT CONTACT YOU BY ELECTRONIC COMMUNICATION PRIOR TO YOUR APPROVAL

Social Security No.: (Please bring to initial meeting)

Date of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Please enter a number from 1 to 100.

Occupation/Employer

Business Address

Street Address Address Line 2 City State ZIP Code

Are you a U.S. citizen?(Required)

Yes

Are you currently married?(Required)

Do you have children or other living relatives?(Required)

Spouse's Name(Required)

First Middle Last Maiden

Primary Phone(Required)

Business Phone

Cell Phone

E-mail Address(Required)

WE WILL NOT CONTACT YOU BY ELECTRONIC COMMUNICATION PRIOR TO YOUR APPROVAL

Social Security No.: (Please bring to initial meeting)

Date of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Please enter a number from 1 to 100.

Occupation/Employer

Business Address

Street Address Address Line 2 City State ZIP Code

Is Spouse a U.S. citizen?(Required)

Yes

Date of your marriage(Required)

MM slash DD slash YYYY

Location of Marriage(Required)

City State / Province / Region Country

Were you or your spouse married to other individuals previously?

Yes

If yes, please indicate which of you was previously married, whether the marriage(s) ended by reason of death or divorce (and the date), and provide any information which might have a bearing on your estate plan (e.g. Premarital Agreement, Divorce Decree obligations).(Required)

Children(Required)

Child's Name

Date of Birth

SS #

Adopted?

Born of Prior Marriage?

Married?

Do any of your children have any special considerations we should be aware of, such as a disability, marital concerns, financial irresponsibility, or legal issues?(Required)

Yes

Please deatil your childrens special considerations (disability, marital concerns, financial irresponsibility, and/or legal issues)(Required)

Nearest Living Relatives

Please include the names, addresses, and relationship of any parents, grandchildren, siblings, etc. of each of you:

Name

Relationship

Address

Do you/spouse presently have:

Last Will and Testament(Required)

Yes

Trust Agreement(Required)

Yes

Power of Attorney for financial matters(Required)

Yes

Health Care Directive/Living Will(Required)

Yes

Pre-nuptial or post-nuptial agreement(Required)

Yes

Settlement agreement with a prior spouse or a court decree involving division of property, spousal or child support, etc.(Required)

Yes

If so, where are the original documents located?(Required)

*If this office did not prepare the documents, please provide copies

Advisors

Type

Name

Phone

Address

Are either of you veterans?(Required)

Yes

If so, please indicate which spouse, service number, and any service disability.(Required)

Pension(Required)

Yes

Beneficiary(s)(Required)

Do you have a Safe Deposit Box?(Required)

Yes

Name of bank(s)(Required)

Name(s) on Lease(Required)

Deputies, if any

Have you previously made gifts of property, including cash, by direct gift, by creating a joint tenancy, or by creating a trust?(Required)

Yes

If yes, did the amount of gifts to any one person in any calendar year

Total $14,000 or more for any year 2014 through present?(Required)

Yes

Involve a life insurance policy of any value?(Required)

Yes

Get reported on a gift tax return?(Required)

Yes

If yes to any, please give detail and attach copies of any gift tax return(s).(Required)

During your marriage, did you ever reside in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI)?(Required)

Yes

If yes, give detail concerning when (dates), and any property acquired while living in such state(s) which you still own(Required)

Are there any other benefits which you own, or expect to obtain in the future, which should be considered, such as an inheritance, trusts, civil service, etc.? If so, list which of you is the beneficiary of such benefits and briefly describe

All property owned by you and your spouse, or in which either or both of you have an interest, must be considered. The following pages provide for information on various types of property. Please provide as much information as possible, particularly the values. List the value under the appropriate column based on ownership. For example, if the residence has a value of $50,000 and is jointly titled, put the $50,000 value in the “Joint” column; or, if each of you own stock in your individual names, put the values in each applicable column.

Real Estate

Address

Type of Property

You

Spouse

Joint

Type of Property (e.g. residence, vacation, vacant land, rental, commercial, etc.):

Motor Vehicle

Year, Make, Model

Loan(s)

You

Spouse

Joint

Include all cars, boats, trailers, aircraft, recreational vehicles, campers, motorcycles, etc.

Bank Account

Type

You

Spouse

Joint

Include all types of “cash” accounts, such as checking and savings accounts, certificates of deposit, credit union, etc.

Securities

Type

You

Spouse

Joint

Include all stock (both public and closely held), bonds, promissory notes, mortgages, money market funds and other similar property in which you have any interest.

Retirement Assets

Name of Company

Type of Plan

You

Spouse

Beneficiary(ies) (Primary and Contingent)

Life Insurance

Name of Company

Type of Policy

Name of Insured

You

Spouse

Beneficiary(ies) (Primary and Contingent)

Include all policies, even if there is no value, including insurance through your employer. Place face amount (amount payable at death) in column of owner.

Business Interests

Entity Name

Address

Type of Business

Ownership Interest

Sucession Plan?

You

Spouse

Joint

Include any interest in sole proprietorships, partnerships, joint ventures, LLCs, or corporations.

Household & Personal Goods; Other Assets

Type*

You

Spouse

Joint

*Household Goods, Furniture, Personal Effects, Etc.

Please provide your best estimate as to the value of your household and personal goods. Include all furniture, household goods, personal effects and similar items as one amount. List any antiques, pieces of art, collectibles, etc., separately if of significant value. List any other asset which has a significant value.

Do you own any cryptocurrency (e.g. Bitcoin, Dogecoin, Ethereum) or NFTs?(Required)

Yes

Do you own any copyrights, patents or other intangibles that might have value and would require special treatment?(Required)

Yes

Are you the creator?(Required)

Yes

If yes, please list and send copies of any filings(Required)

Do you own any firearms?(Required)

Yes

If yes, are any of these firearms federally registered (e.g. machineguns, semi-automatic, silencers, etc.)?(Required)

Yes

Do you own or possess any amounts of marijuana or related items made legal under Article XVI of the Missouri Constitution?(Required)

Yes

Do you possess any genetic material (e.g. sperm donation, frozen embryos, etc.)?(Required)

Yes

Have you ever donated such genetic material?(Required)

Yes

The most important part of our work is ensuring that your plans and desires are accurately reflected in your estate plan. Your initial objectives, concerns, and decisions, both generally and specifically, are therefore of utmost importance. Please attach any additional information you feel would be helpful. Keep in mind we will discuss these issues at our initial conference.

In general terms, what are your primary goals or objectives in setting up an estate plan?(Required)

In general terms, who should receive your property upon your deaths and on what terms (outright, in trust, other)?(Required)

If you have minor children, who would you prefer to act as guardian if both of you are deceased?

Who should serve as Trustee of your trust or as Personal Representative of your Wills to ensure your wishes are carried out according to your estate plan, and who should serve as backup(s)?(Required)

Items of personal property (e.g. jewelry, china, guns, etc.) can be distributed to specific individuals by a list separate from your will or trust. What items, if any, do you want to give to specific persons under your will or trust?(Required)

Do you have amounts you want given to other beneficiaries (e.g. individuals or charities)?(Required)

Yes

If yes, please specify(Required)

Do you have any specific burial instructions (cremation, specific funeral arrangements)?

Do you want to make anatomical gifts upon your death (gift of your body for education, research and/or advancement of medical science, transplants, etc)?(Required)

Yes

If yes, please specify(Required)

Are you, or any potential beneficiary of your estate, a recipient of any need-based governmental benefit program, such as Supplemental Security Income (“SSI”) or Medicaid?(Required)

Yes

If yes, please list the individual and the benefits that he/she is currently receiving.(Required)

Have you made any gifts under the Uniform Gifts to Minors Act (UGMA) or Uniform Transfers to Minors Act (UTMA), sometimes referred to as custodial accounts?(Required)

Yes

If so, are you or your spouse the custodian of any such accounts?(Required)

Yes

Do you own property jointly with someone other than your spouse or do you own property which is payable on your death (by beneficiary designation) to someone other than your spouse?(Required)

Yes

If yes, please describe(Required)

Do you hold any 529 college savings plans?(Required)

Yes

Does a third party (individual or corporation) own life insurance on your life?(Required)

Yes

If so, please indicate the name of the owner, the cash value, and the face amount of the policy(ies).(Required)

Do you own life insurance on the life of someone else?(Required)

Yes

If yes, please indicate the name of the insured, the cash value, and the face amount of the policy(ies).(Required)

Do any family members owe you money?(Required)

Yes

If yes, provide details(Required)

Do you have a prepaid funeral or burial plot?(Required)

Yes

If yes, with whom?(Required)

Do you have long-term care insurance?(Required)

Yes

If yes, with whom?(Required)

Do you have any income sources from online sales or other digital transactions?(Required)

Yes

If so, please describe.(Required)

If you own pets, who should care for them after your deaths?

Do you have a complete list of e-mail addresses, passwords and answers to security questions for each online service that you use?(Required)

Yes

Do you have a list of all of your computers, notebooks, smart phones or other electronic devices that you use, as well as a list of the passwords that you use to access these devices?(Required)

Yes

Have you filled out a copy of our digital asset inventory list?(Required)

Yes

If so, where will it be located?(Required)

Do you have specific desires on how you want your digital assets disposed of at death (e.g., who should manage, how distributed, destroyed or deactivated)?

If you have any questions or need additional space for any of the previous sections; please refer to the section for which you are providing additional information.

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Estate Planning Questionnaire

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