Estate Planning Questionnaire — Harlow & Cole Estate Law

1. About You & Your Household

Relationship status

Married Single Divorced Widowed

Your full legal name

Spouse/partner's full legal name

Your date of birth

Spouse/partner's date of birth

Your Social Security Number

Spouse/partner's Social Security Number

Home address

City

State

ZIP

Mailing address (if different)

Home phone

Do you anticipate relocating soon?

Yes No

Do you currently have a Will or Trust?

Yes No

Your employer / work phone

Spouse/partner's employer / work phone

Expecting a gift or inheritance?

Yes No

Any previous marriages (either of you)?

Yes No

2. Your Children

List each child. Attach an extra sheet later if you have more than four.

Children

Full legal name

Address

City

State

ZIP

Date of birth

Natural / Adopted / Married / Special care

Related to (you / both / spouse)

Full legal name

Address

City

State

ZIP

Date of birth

Natural / Adopted / Married / Special care

Related to (you / both / spouse)

Full legal name

Address

City

State

ZIP

Date of birth

Natural / Adopted / Married / Special care

Related to (you / both / spouse)

Full legal name

Address

City

State

ZIP

Date of birth

Natural / Adopted / Married / Special care

Related to (you / both / spouse)

Grandchildren — your side

Grandchildren — spouse's side

3. Your Estate Planning Team

Trustee(s)

Trustee name

Address

Trustee name

Address

Backup Trustees / Executors (in order of preference)

Name

Address

Act alone or together?

Name

Address

Act alone or together?

Name

Address

Act alone or together?

Guardians for Minor Children

Name

Address

Name

Address

4. Beneficiaries & Gifts

Specific gifts to individuals, charities, or organizations

Recipient name

Address

Description of gift

Recipient name

Address

Description of gift

Recipient name

Address

Description of gift

Beneficiaries of the remainder of your estate

Name

Address

Amount / percentage

Name

Address

Amount / percentage

Name

Address

Amount / percentage

How should beneficiaries receive their inheritance?

Any dependents needing special care (aging parent, disabled child, government benefits)?

Alternate beneficiaries (if a primary beneficiary predeceases you)

Name

Address

Amount / percentage

Name

Address

Amount / percentage

Relatives you wish to specifically exclude

Name

Reason

Name

Reason

5. Financial Picture

Real estate

Description / location

Purchase price

Current value

Mortgage balance

Description / location

Purchase price

Current value

Mortgage balance

Description / location

Purchase price

Current value

Mortgage balance

Other titled property (vehicles, boats, etc.)

Description

Value

Description

Value

Cash & cash-equivalent accounts

Institution

Account type

Account #

Value

Institution

Account type

Account #

Value

Institution

Account type

Account #

Value

Stocks, bonds, mutual funds

# shares

Description / location

Account #

Value

# shares

Description / location

Account #

Value

# shares

Description / location

Account #

Value

Retirement accounts

Type

Account #

Institution

Owner

Value

Type

Account #

Institution

Owner

Value

Type

Account #

Institution

Owner

Value

Life insurance, LTC insurance, annuities, umbrella coverage

Company

Policy #

Type

Beneficiary(ies)

Value

Company

Policy #

Type

Beneficiary(ies)

Value

Company

Policy #

Type

Beneficiary(ies)

Value

Business or partnership interests

Description

Value

Description

Value

Money owed to you

Name

Address

Description

Value

Name

Address

Description

Value

Special valuables (coins, antiques, jewelry, etc.)

Description

Value

Description

Value

Approx. value of remaining personal property (furnishings, etc.)

Debts other than your mortgage

Description

Amount

Description

Amount

Total value of everything you own

Total amount you owe

Net estate value

Safe deposit box location

How titled

Who has access

6. Incapacity, Medical Care & Final Wishes

Special instructions if you become physically or mentally incapacitated

Medical care preferences — preferred/avoided facilities, feelings on life support

Advance Health Care Directive agent(s)

Name

Address

Name

Address

Special instructions for funeral or burial

Cemetery lot location

Burial or cremation preference

Burial Cremation Undecided

Other special wishes

Questions you'd like to ask your attorney

Question for your attorney

Online Intake Form

1. About You & Your Household

2. Your Children

Children

3. Your Estate Planning Team

Trustee(s)

Backup Trustees / Executors (in order of preference)

Guardians for Minor Children

4. Beneficiaries & Gifts

Specific gifts to individuals, charities, or organizations

Beneficiaries of the remainder of your estate

Alternate beneficiaries (if a primary beneficiary predeceases you)

Relatives you wish to specifically exclude

5. Financial Picture

Real estate

Other titled property (vehicles, boats, etc.)

Cash & cash-equivalent accounts

Stocks, bonds, mutual funds

Retirement accounts

Life insurance, LTC insurance, annuities, umbrella coverage

Business or partnership interests

Money owed to you

Special valuables (coins, antiques, jewelry, etc.)

Debts other than your mortgage

6. Incapacity, Medical Care & Final Wishes

Advance Health Care Directive agent(s)

Questions you'd like to ask your attorney