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Estate Planning Questionnaire

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It is advisable that you seek the counsel of an experienced estate planning attorney to help you through the process of making an estate plan.  In order to do the best possible job on your behalf, your attorney needs information about you and your assets.  At your first meeting with your attorney, you should be prepared to provide, as applicable, the following information:It is advisable that you seek the counsel of an experienced estate planning attorney to help you through the process of making an estate plan.  In order to do the best possible job on your behalf, your attorney needs information about you and your assets.  At your first meeting with your attorney, you should be prepared to provide, as applicable, the following information:



Name(s): _______________________________________    Date of Birth:_____________

  _______________________________________    Date of Birth:_____________

Mailing Address: __________________________________________________________


Telephone Nos.: (Work) ______________________ (Home) ______________________

   (Mobile) _____________________

E-mail Address: ____________________________


Do you have an existing Will(s) ?    [   ] Yes    [   ] No
(If yes, provide your attorney with a copy)


Marital Status:

 [   ] Husband and Wife
 [   ] Unmarried, Widow or Widower
 [   ] Unmarried, Divorced
 [   ] Married Person Establishing Separate Trust

        Indicate Whether Adopted
Name        Date of Birth  or from a Previous Marriage

__________________      _________   ______________________________
__________________      _________   ______________________________
__________________      _________   ______________________________
__________________      _________   ______________________________

Any deceased children?    [   ] Yes [   ] No

If Yes, Name of Deceased Child: _________________________________
Did this deceased child leave any children?   [   ] Yes    [   ] No

Name of Deceased Child: _________________________________
Did this deceased child leave any children?   [   ] Yes    [   ] No

Have any children received an advance on their inheritance or are any children financially indebted to you?      Yes       No

Is there any reason to treat your children other than equally?


Are any of the children financially irresponsible? [   ] Yes    [   ] No

Are any of the children under a disability?   [   ] Yes    [   ] No

Have you been married previously?    [   ] Yes    [   ] No

If any child should predecease a parent, should his/her share pass through to his/her children?        [    Yes        No

 If Yes to the above, please indicate grandchildren, if any:

 Name   Date of Birth   Parents

 In the event of your death, who should be guardian of your minor children?  (a guardian has physical and legal control over your children until they reach the age of eighteen)

 First choice:   Name(s):____________________________________________________


 Relationship (if any):______________________________________________________

 Second choice:

 Relationship (if any):______________________________________________________

 Other Pertinent Family Information or Explanation of Above Items:




 Do you wish to have a trust established for the benefit of your spouse and/or children? 
  Yes        No

If yes to the above, please indicate who the trustee(s) should be.  (A trustee manages the assets for your children or other beneficiaries until they reach specified ages.  If you do not establish a trust, children inherit at age eighteen.  You may name an individual, bank or trust company, or both.)

First choice:   Name(s):____________________________________________________


Alternate trustee:


Terms of distribution (education, marriage, etc.)_________________________________

Ages(s) for distribution to children from the trust (Ex.: 1/3 at age twenty-one, 1/3 at age twenty-five, 1/3 at age thirty)



Who should be Personal Representative (“executor”) of your estate?  (A Personal Representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate.)

First choice (Spouse is normally named first):___________________________________



Second Alternate:



Do you wish to make reference in your will to a separate list of any specific bequests of items of personal property that you wish to give to children or others?  The advantage of such a list is that it may be changed without changing your will.      Yes       No

Do you wish to make any charitable bequests?     Yes       No

Do you have a safe deposit box? If so, where?___________________________________

Does anyone else have access to your box?_____________________________________


Are you interested in preparing a Power of Attorney granting another person the power to act on your behalf to manage your assets and pay your bills if you become incompetent or unable to sign your name?     Yes       No

Are you interested in preparing a Health Care Declaration (“Living Will”) stating your preference for health care if you are in a terminal condition?     Yes       No

If you are executing a Living Will or Health Care Declaration, please give your primary physician’s name and address:


Do you have any special requests regarding funeral or burial instructions or organ donation?  If so, this is best handled by a Letter of Instruction or other statement from your will to your family or other responsible person.     Yes       No

Do you have a financial planner, investment advisor, or insurance agent?
   Yes       No
If Yes to the above, please give name and address:_______________________________



Married Couples:

 [   ] Husband has separate assets.
 [   ] Wife has separate assets.
 [   ] All assets are held jointly.

1.  Estimated net worth of estate: $ ____________________

2.  Cash or cash equivalent accounts held at financial institutions:
 [   ]  Checking and savings accounts, or certificates of deposit, with banks, savings and loans, or credit unions.  How many different financial institutions? ________

3.  Investments (check all that apply):
 [   ] Cash or money fund accounts, or certificates of deposit with stock broker firms.
  How many different broker firms? ________
 [   ]  Stocks, bonds, and mutual funds where your broker holds the certificates and sends you periodic statements showing your account balance.
  How many different stock brokerage firms? ________
 [   ]  Mutual funds where you deal directly with the issuing company rather than through your stock broker.  How many different mutual fund companies? _______
 [   ]  Stocks and bonds (other than U.S. Savings Bonds) where you hold the certificates in your possession.  How many different companies/issuers? ________
 [   ]  U.S. Savings Bonds.
 [   ]  Treasury bills or other government securities.
 [   ]  Limited partnerships.   How many limited partnerships? ________
 [   ]  Oil and gas royalty or working interests. How many? ________
 [   ]  Oil and gas mineral rights in land. How many parcels of land? _________
 [   ]  Other securities [describe] ______________________________________

4.  Retirement plans:
 [   ]  Individual retirement accounts (IRAs), Keogh, or other individual plans providing tax deferment for deposits and income. How many different financial institutions hold IRA accounts for:  Husband  _____ Wife  _____
 [   ]  Employer provided profit sharing, retirement, or other benefit plans:
  How many different plans for:  Husband  ______ Wife  ______

5.  Complete this section if you own real estate.

 [   ]  Personal residence located in state of _______________________
 [   ]  Other property. How many different parcels of real estate do you own, other than your personal residence?_________
  In what state(s) are these parcels located?_________________ 
  Are you purchasing any of the above properties on a contract for deed?
  [   ] Yes   [   ] No.  If Yes, provide details:_______________________



6.  Complete this section if you are engaged in business.

 Do you own a business, or are you a partner in a business?  [   ] Yes  [   ] No
  If Yes, complete the following:
 [   ]  Business is organized as a corporation. How many corporations? _______
  How many corporations are subchapter S corporations?_______
 [   ]  Business is organized as a partnership. How many partnerships? _______
 [   ]  Business is a sole proprietorship. How many different firms? _______

7. Receivables:  If any money is owed to you, as payments on contracts, where you have sold a business, as payments on obligations secured by real estate, or where you have loaned money to someone and you hold a note, indicate each type of indebtedness that you hold.
 [   ] Promissory note(s) secured by real estate.  Amount(s) owed:___________
 [   ] Installment contract(s) of sale of personal property.
 Amount(s) owed:____________
 [   ] Unsecured promissory note(s).  Amount(s) owed:_____________

8. Life Insurance Policies:  Please indicate the name of the person insured, the name of the insurance company, the face amount of the policy, and the type of policy.

Name of Insured        Insurance Company          Face Amount Type of Policy

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

__________________       ______________________        __________         ________

9.  Annuities: Please indicate the name of the annuitant and the type of annuity.  Do not list annuities under which no benefits are payable after the death of the annuitant.
 Regular annuities payable for guaranteed minimum term or amount:

 Tax deferred annuities: ______________________________________________________

10.  Personal property other than automobiles, trucks, boats, and trailers:
 [   ] Household furniture and appliances
 [   ] Collections, art, antiques, valuable jewelry
 [   ] Automobiles 
 [   ] Boats
 [   ] Recreational vehicles
 [   ] Motor home
 [   ] Business machinery and equipment
 [   ] Personal equipment and tools
 [   ] Farm or ranch machinery and equipment (other than general household tools)
 [   ] Livestock


(Make a list of pertinent questions to ask your attorney)


Next Steps
Contact a qualified estate planning attorney to help you ensure
that your loved ones are cared for and your wishes are honored.
(e.g., Chicago, IL or 60611)

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