Estate Planning Checklist

Estate Planning Information Sheet

Date completed

All information will be kept CONFIDENTIAL, unless you authorize or request its release to others.

The purpose of this questionnaire is to: 1) help you organize personal and financial information so that you can assess your current estate plans and evaluate whether changes are necessary; and (2) provide me with the information needed to make a similar analysis.

Note: Not all of the questions will apply to your circumstances.

Will & Trust Background Information

Do you have a will?

Yes

Do you have a trust?

Yes

PERSONAL INFORMATION

State the names requested below exactly as you want them to appear in your estate planning documents.

Your legal name:

Your Date of birth

Spouse's/partner's legal name:

Spouse's Date of birth

Date of marriage (if married)

Are you subject to a Prenuptial Agreement?

Yes

Your Home Address

City

State/Province

Zip/Postal

Country

Your Email

Spouse's Email (if applicable)

Telephone No. (s)

(home)

(your cell)

(spouse's cell)

Are you a United States citizen?

Yes

Is your spouse a United States citizen?

Yes

PRIOR MARRIAGES

(if applicable)

Name of Prior Spouse

Date of Marriage

Date of Divorce

FAMILY INFORMATION

Please name all of your children. If a child is from a former marriage, please indicate whose child it is by listing the name of that spouse, along with the information of WHOSE child in the chart below. Please name all children you have ever had, including deceased children (whether or not their descendants will be included in your plan). Please note if the child is adopted or a step-child. If you do not have any children, please list: (1) Names of Parents (living or deceased); and (2) Names of any siblings (living or deceased).

Full Name

Relationship

Whose? Or Both?

Birth date

Single? Married? Divorced? Single? Married? Divorced?

Town and State of Residence

Do any of the people identified above have any special mental, physical or educational needs? If so, please identify them and briefly describe any concerns.

If you have any specific wishes for your pets, please list them here:

PERSONAL AND FAMILY FINANCIAL ASSETS

Please indicate:

Your current place of employment:

Spouse's current place of employment:

Real Estate Ownership

Address

Mortgage balance

Current market value

Asset Summary

Current assets and liabilities:

TOTAL ASSETS (excluding insurance)

You

Spouse

Joint

Liabilities

Total Liabilities

You

Spouse

Joint

Other interests of current or future value

1. Interests in trusts:

Describe any trusts created by you or inherited, in which you or a member of your immediate family has a right to receive distributions of income or principal . Also state the approximate current value of the trust and the annual income from it.

PERSONAL ESTATE PLANNING OBJECTIVES

1. Please list any specific bequests of personal property or money that you would like to leave and to whom.

2. How would you like the remainder of your personal property distributed?

3. How would you like the remainder of your other assets distributed?

4. If you have children, upon your death do you want them to receive their share of your estate outright or in trust?

5. If you leave assets directly to a child or children, how should their share be distributed if they fail to survive you? (to their children, back to other children/descendants or elsewhere)

6. If you decide to leave your assets to your children in a trust, at what age or ages would you want them to receive the principal?

7. In the event of an unforeseen situation that was to claim the lives of your entire immediate family where would you want your assets to go?

8. Do you intend to disinherit anyone? If so, please provide their name(s) and your relation to them.

9. Is there anyone likely to contest your estate documents? If so, whom?

GUARDIANS, EXECUTORS AND TRUSTEES

1. Guardians for minor children

If you have minor children, who would you like to designate as a guardian or guardians of the person and their estate if you and your spouse were to die or become incapacitated.

(a) Guardian

Name

Address

City

State/Province

Zip/Postal

Country

(b) Successor Guardian.

Name

Address

City

State/Province

Zip/Postal

Country

2. Executor

Your executor has the responsibility to wind up your affairs at the time of your death. Who would you like to designate as your Executor(s) upon your death and the death of your spouse?

(a) Executor

Name(s)

Address

City

State/Province

Zip/Postal

Country

(b) Successor Executor. (to act if one or more of the initial executor(s) cannot or does not act.)

Name(s)

Address

City

State/Province

Zip/Postal

Country

3. Trustees

If you choose to form a trust, your trustees are responsible for the management of the trust, and distribution of the trust funds. Whom would you like to designate as Trustee(s)?

Note: Generally the trustee of your trust and guardian of your children should not be the same person.

(a) Initial trustees or Co-trustee(s)

Name(s)

Address(es)

(b) Successor Trustees (to act if one or more of the initial trustee(s) cannot or does/do not act).

Name(s)

Address(es)

OTHER MATTERS

1. Powers of attorney

Would you like us to prepare a general durable Power of Attorney? This document would allow someone to handle financial matters on your behalf.

Yes

2. Health Care Instructions

Would you like us to prepare a document indicating your wishes concerning the extraordinary measures to be taken to save your life in the event of a catastrophic illness or injury? This would authorize another person to make decisions with respect to your health care in the event you are unable to do so, and designate a conservator in the event one is needed.

Yes

3. Cremation/Burial Service Arrangement

Do you want to be cremated?

Yes

Do you want to be buried?

Yes

Name(s), addresses and phone numbers of the person(s) you would you like to select in order to make arrangements?

Name

Address

Phone Number

4. Other Estate Planning Matters

Are there any other estate planning matters you would like us to address for you?

Yes

If you are human, leave this field blank.

Scott B. Franklin

Estate Planning Information Sheet

All information will be kept CONFIDENTIAL, unless you authorize or request its release to others.

Will & Trust Background Information

PERSONAL INFORMATION

PRIOR MARRIAGES

FAMILY INFORMATION

PERSONAL AND FAMILY FINANCIAL ASSETS

Please indicate:

Asset Summary

TOTAL ASSETS (excluding insurance)

Liabilities

Total Liabilities

Other interests of current or future value

PERSONAL ESTATE PLANNING OBJECTIVES

GUARDIANS, EXECUTORS AND TRUSTEES

OTHER MATTERS

1. Powers of attorney

2. Health Care Instructions

3. Cremation/Burial Service Arrangement

Name(s), addresses and phone numbers of the person(s) you would you like to select in order to make arrangements?

4. Other Estate Planning Matters

Scott B. Franklin

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Scott B. Franklin