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Sample Form

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SAMPLE

ESTATE PLANNING QUESTIONNAIRE

 

Date:

PERSONAL INFORMATION

 

Name:

Social Security No.

Date of Birth:

 

Name of Spouse:

 

Social Security No. 

 

Date of Birth: 

 

 

Address: 

 

City: 

State: 

ZIP: 

 


 

CHILDREN AND GRANDCHILDREN

 

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

Child:     Relationship:

 


 

BENEFICIARIES UNDER YOUR WILL AND TRUST

 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

FIDUCIARIES

 

Executor(s), Administrator(s): (Will)

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Alternate Executor: (If the 1st Executor cannot perform)

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Successor(s) Trustee: (Trust)

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Alternate Trustee: (If the 1st trustee cannot perform)

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Children's Guardian(s):

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Successor(s):

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

 


 

Power of Attorney:

Name: 

Relationship: 

Address: 

City: 

State: 

ZIP: 

Alternate: 

 


 

FINANCIAL INFORMATION

Real estate including homes, condominiums, recreational property and rental property

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


 

Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 

 


Description or Address: 

Date Acquired: 

Mortgagor: 

Amount: 


 

Cash and Investments

Name and address of financial institution:
 

Name: 

 

Account Number: 

Checking or Savings: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

 

Account Number: 

Checking or Savings: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

 

Account Number: 

Checking or Savings: 

Address: 

City: 

State: 

ZIP: 

 


 

Name: 

 

Account Number: 

Checking or Savings: 

Address: 

City: 

State: 

ZIP: 

 


Stocks and Bonds

Name: 

 

Number of Shares: 

Value: 

Date Acquired: 

Cost: 

 


 

Name: 

 

Number of Shares: 

Value: 

Date Acquired: 

Cost: 

 


 

Name: 

 

Number of Shares: 

Value: 

Date Acquired: 

Cost: 

 


 

Name: 

 

Number of Shares: 

Value: 

Date Acquired: 

Cost: 

 


 

Name: 

 

Number of Shares: 

Value: 

Date Acquired: 

Cost: 

 


 

Life Insurance

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Company: 

 

Policy Number: 

Beneficiary: 

Face Amount of Policy: 

Cash Surrender: 

 


 

Annuities and Retirement Benefits (Including IRA's)

 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

Annuity or Type of Plan: 

 

Annuity Beneficiary: 

Value: 

 


 

DESCRIPTION OF ALL OTHER ASSETS

(To avoid confusion try and describe each item as clearly as possible)

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

Description: 

Estimated Value: 

 


 

SPECIAL INSTRUCTIONS

(Items that will be left specifically or treated out of the ordinary terms)
(To avoid confusion try and describe each item as clearly as possible)

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