Estate Planning Questionnaire | Vance E. Hendrix P.C.

New Client - Estate Planning Questionnaire

THE INFORMATION IN THIS DOCUMENT IS SUBJECT TO THE ATTORNEY-CLIENT PRIVILEGE, CONTENTS OF THIS DOCUMENT ARE CONFIDENTIAL AND WILL NOT TO BE DISCLOSED TO THIRD PERSONS OTHER THAN IN FURTHERANCE OF PROFESSIONAL LEGAL SERVICES.

PLEASE COMPLETE THE FOLLOWING.

Clear Form

PERSONAL DATA

NAME*

Address*

City*

State*

Zip Code*

Cell #*

Work #

E-mail*

SPOUSE NAME (if applicable)

Address

City

State

Zip Code

Cell #

Work #

E-mail

FAMILY INFORMATION

CHILDREN

Name

Birthdate

Address

Name 1

Birthdate 1

Address 1

Name 2

Birthdate 2

Address 2

Name 3

Birthdate 3

Address 3

Name 4

Birthdate 4

Address 4

Name 5

Birthdate 5

Address 5

Name 6

Birthdate 6

Address 6

Explain:

YOUR ESTATE

Describe to whom you wish your Estate to pass upon your death, including any specific gifts.

CHARITABLE BEQUESTS

Describe any charitable bequests you wish to make, including any specific bequests to charity.

BURIAL AND CREMATION INSTRUCTIONS BEQUESTS

If you wish to include burial or cremation instructions in your estate planning documents, please describe such burial or cremation instructions below.

DESIGNATION OF GUARDIAN FOR MINORS

If you have a child under the age of 18 and wish to designate a person or persons to serve as guardian for such child, please identify the person or persons below, including their name, address, and telephone number.

FIDUCIARIES

EXECUTORS AND TRUSTEES

EXECUTORS

Name

Address

Telephone #

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

TRUSTEES

Name

Address

Telephone #

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

SPOUSE EXECUTORS AND TRUSTEES

EXECUTORS

Name

Address

Telephone #

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

TRUSTEES

Name

Address

Telephone #

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

AGENTS

POWER OF ATTORNEY

Please identify the individuals that you wish to serve as your agents below.

MEDICAL POWER OF ATTORNEY

Name

Address

1st Agent:

Name

Address

2nd Agent:

Name

Address

3rd Agent:

Name

Address

DURABLE POWER OF ATTORNEY

Name

Address

1st Agent:

Name

Address

2nd Agent:

Name

Address

3rd Agent:

Name

Address

SPOUSE'S POWER OF ATTORNEY

Please identify the individuals that you wish to serve as your agents below.

MEDICAL POWER OF ATTORNEY

Name

Address

1st Agent:

Name

Address

2nd Agent:

Name

Address

3rd Agent:

Name

Address

DURABLE POWER OF ATTORNEY

Name

Address

1st Agent:

Name

Address

2nd Agent:

Name

Address

3rd Agent:

Name

Address

ASSETS

Estimated Net Worth:

Estimated Total Value of Community Property:

Estimated Total Value of Husband’s Separate Property:

Estimated Total Value of Wife’s Separate Property:

Does the total value of your Estate exceed $25,840,000.00 for a married couple (or $12,920,000.00 for an individual)? YesNo

REAL ESTATE

For all Real Estate (Land/houses, etc., identify the Location/Address (include County of location).

Address

Equity

Value

Address 1

Equity 1

Value 1

Address 2

Equity 2

Value 2

Address 3

Equity 3

Value 3

Address 4

Equity 4

Value 4

Address 5

Equity 5

Value 5

Address 6

Equity 6

Value 6

OIL, GAS, AND MINERAL INTERESTS

For all oil, gas, and minerals that you own, identify the county in which such minerals are located.

BANKS AND BROKERAGE ACCOUNTS

Identify all Institutions at which you maintain an account.

Name of Bank/Brokerage Firm

Acct #

Beneficiary Designations

Value

Name of Bank/Brokerage Firm 1

Acct 1

Beneficiary Designations 1

Value 1

Name of Bank/Brokerage Firm 2

Acct 2

Beneficiary Designations 2

Value 2

Name of Bank/Brokerage Firm 3

Acct 3

Beneficiary Designations 3

Value 3

Name of Bank/Brokerage Firm 4

Acct 4

Beneficiary Designations 4

Value 4

Name of Bank/Brokerage Firm 5

Acct 5

Beneficiary Designations 5

Value 5

Name of Bank/Brokerage Firm 6

Acct 6

Beneficiary Designations 6

Value 6

Name of Bank/Brokerage Firm 7

Acct 7

Beneficiary Designations 7

Value 7

Name of Bank/Brokerage Firm 8

Acct 8

Beneficiary Designations 8

Value 8

Name of Bank/Brokerage Firm 9

Acct 9

Beneficiary Designations 9

Value 9

OTHER ASSETS (Business interests, Retirement Accounts, Digital Assests such as bitcoin, Trademarks, Patents, Copyrights, etc.)

PROFESSIONAL ADVISORS

Please identify your professional advisors

Accountant:

Insurance Agent:

Financial Advisor:

Have you created a list or database of your automatic draft payments? YesNo

Have you created a list or database of your passwords for digital accounts? YesNo

Have you left any written instructions for your family upon your passing? YesNo

ITEMS TO BRING TO CONSULTATION

Wills and any codicils
Trust instruments in which client is grantor, trustee, or beneficiary
Deeds to property

CUSTOM LEGAL SOLUTIONS

Every client I meet has their own unique story and set of priorities. I’ve had clients express concerns ranging from “I don’t want my grandson to blow his inheritance in two weeks” to “I don’t know anything about tax planning. Where should I start?” As these factors are revealed, I also learn a little bit more about what needs to go into that particular estate plan — or marital agreement, or business contract, or whatever else the situation may call for. Fortunately for my clients, this is where I truly excel in my practice.

I cannot speak for my clients, but each time they send a friend or member of their family to me, I take that referral as a sign that I am approaching my practice in a way that they appreciate. To ensure that I continue to do so, I also work to stay up-to-date with the latest developments in the law. In addition, I regularly remind my clients that their questions are welcome.