ESTATE PLANNING PERSONAL DATA SHEET

(MARRIED)

 

Date                                   Tel. Home                                      Tel. Bus.                                 

This form is extremely important.  Your accuracy and completeness in responding will help me best represent you.  Bring this information with you to the appointment.  Please list names as they would appear on legal documents.

 

 

PERSONAL DATA

 

(Husband)                                                                              (Wife)

Full Name                                                                Full Name                                                   

                     (print name as shown on your checks)                                    (print name as shown on your checks)

 

Address                                                                                                                                  

 

                                                                                                               Zip                         

           

(Husband)                                                                            (Wife)

Birth Date                                                                          Birth Date                                                    

 

Social Security Number                                                       Social Security Number                                 

 

U.S. Citizen?  Yes                    No                              U.S. Citizen?  Yes                     No             

 

Annual Income                                                        Annual Income                                            

 

 

REFERRAL

 

By whom were you referred to this office?

 

Name                                                                                                                                     

 

Address                                                                                                                                   

 

DISPOSITIVE INTENTIONS

 

1.  Do you wish to provide primarily for your spouse and secondarily for your children? 

            Yes                                No                        

 

            Do you wish to treat all of your children equally?  Yes                   No                 

 

            After your spouse's death, at what age do you want distribution to  your children:

            (e.g. a typical plan provides for 1/3 at age 25, 1/3 at age 30 and 1/3 at age 35)

 

            Your choice of age:                                                                                                       

 

2.         Do you want to leave a specific amount of money or a percentage of your estate to your              grandchildren?      Yes                     No                

 

            If so, do you wish to treat them equally?   Yes                                No                 

 

            If so, how much?                                                                                                           

 

            Your choice of age:                                                                                                        

 

            For what purpose?                                                                                                         

 

            Beneficiary:                                                                                                                   

 

3.  Do you want to leave a specific amount of money or other assets to any charity?

            Yes                    No                 

 

            If so, how much?                                                                                                           

 

            Name and Address of Charity                                                                                          

 

                                                                                                                                               

 

4.         If you have no children, who do you wish to provide for in your Will?

 

                                                                                                                                               

 

                                                                                                                                                

 

 

EXECUTOR

 

Who do you wish to serve as your Executor?

 

First Choice