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, your assets, and your estate planning goals. At your first meeting with your attorney, you should be prepared to provide, as applicable, the following information:

            NAMES AND ADDRESSES

Name(s):________________ Date of Birth: ________

        ________________ Date of Birth: ________
        
Mailing Address: _______________________________
                 
________________________________________________

Telephone Nos.: (Work)_________  (Home)________
 
 (Mobile)_________________ 
                
E-mail Address:  ________________________


                ESTATE PLAN


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




             FAMILY INFORMATION

Marital Status:

    [] Husband and Wife
    [] Unmarried, Widow or Widower 
    [] Unmarried, Divorced
    [] Married Person Establishing 
       Separate Trust
                  
Children:
                              Indicate Whether 
                   Date of    Adopted or from a 
Name                Birth     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): _______________________________________

Address: _______________________________________

________________________________________________

Relationship (if any): 
________________________________________


Second choice:
Name(s): _______________________________________

Address: _______________________________________

________________________________________________

Relationship (if any): 
________________________________________


Other Pertinent Family Information or 
Explanation of Above Items:

________________________________________________

________________________________________________

________________________________________________


                 TRUST

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): _______________________________________

Address: _______________________________________

________________________________________________


Alternate trustee:
Name(s): _______________________________________

Address: _______________________________________

________________________________________________

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) ________________

________________________________________________


         PERSONAL REPRESENTATIVE

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): 
________________________________________________

Alternate: 
Name: 
________________________________________________

Address: 
________________________________________________


Second Alternate: 
Name: 
________________________________________________

Address: 
________________________________________________

           SPECIFIC BEQUESTS

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? 
________________________________________________


       OTHER ESTATE PLANNING TOOLS

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: ____________________________________

________________________________________________

      INFORMATION REGARDING ASSETS

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      Insurance         Face    Type of 
Insured       Company         Amount    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 tools)
    [] Livestock 

                QUESTIONS

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