ESTATE PLANNING WORKSHEET

 

PERSONAL INFORMATION :

 

Husband:

Full Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Residence Telephone: (____)___________________

Business Telephone: (____)___________________ Ext.____________

Birth date: __________________________________

Birthplace: __________________________________

SS#: ______________________________________

U.S. Citizen: _______

If Not, Which Country: ________________________

Marital Status: ___ Married ___Single ___Widowed ___Divorced

 

Wife:

Full Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Residence Telephone: (____)___________________

Business Telephone: (____)___________________ Ext.____________

Birth date: __________________________________

Birthplace: __________________________________

SS#: ______________________________________

U.S. Citizen: _______

If Not, Which Country: ________________________

Marital Status: ___ Married ___Single ___Widowed ___Divorced

 

 

FAMILY INFORMATION

 

Children From This Marriage:

(1) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

 

(2) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

 

(3) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

 

Adopted Children:

(1) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

PRIOR MARRIAGES

 

Husband’s Former Spouse: _______________________________________________________

Marriage was Severed by Death or Divorce (indicate which): _____________________________

Severance Date: __________________________________

 

Wife’s Former Spouse: _________________________________________________________

Marriage was Severed by Death or Divorce (indicate which): _____________________________

Severance Date: __________________________________

 

Children from this/these marriage(s): (Please indicate which marriage for each child):

(1) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

 

(2) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Social Security No._____________________

Birth date: ____________________________

 

 

YOU NEED TO CHOOSE THE FOLLOWING REPRESENTATIVES

 

(Note: An executor and trustee can be the same person. In general, an executor will handle the many details at your death and a trustee may have ongoing money management responsibilities. Some people elect to have a spouse or close friend as executor and/or money manager or bank trust department as a trustee. It is wise to choose both primary and alternate representatives.)

 

EXECUTOR of Husband’s Estate:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

ALTERNATE:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

EXECUTOR of Wife’s Estate:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

ALTERNATE:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

TRUSTEE of Husband’s Estate:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

ALTERNATE:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

TRUSTEE of Wife’s Estate:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

ALTERNATE:

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

GUARDIAN of minor children in event of husband’s death

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

GUARDIAN of minor children in event of wife’s death

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

GUARDIAN of minor children in event of both husband and wife’s death

Name: _______________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

 

DISTRIBUTION

 

Upon my death, I desire my estate to be distributed as follows:

 

Surviving Spouse: ___________%

 

Others:

 

(1) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

(2) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

Specific gifts to certain/special people:

 

(1) Name: ____________________________________________________________________

     Gift: ______________________________________________________________________

 

(2) Name: ____________________________________________________________________

     Gift: ______________________________________________________________________

 

(3) Name: ____________________________________________________________________

      Gift: ______________________________________________________________________

 

(4) Name: ____________________________________________________________________

      Gift: ______________________________________________________________________

 

Upon the death of the surviving spouse, the estate to be distributed is as follows:

 

(1) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

(2) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

(3) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

(4) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

(5) Name: ____________________________________________________________________

Address: _____________________________________________________________________

                  Street                                     City                            State                   Zip

Percent: ________________%

 

ASSETS:

 

Real Estate: (also include minerals): ________________________

 

Vehicles, Automobiles, Boats, etc: _________________________

 

Life insurance: (name of insurance company, address of company, face amount, owner of policy,

beneficiary, policy number) _________________________________

 

Securities: (stocks, bonds, mutual funds) -- brokerage account number, owner of account, Series EE bonds, Series HH bonds, if securities owned in certificate form, certificate number, CUSIP number, number of shares, name and address of stock transfer agent, how ownership is currently

styled: ________________________________________

 

Money owed to you: (date of note, payor, amount, if secured bymortgage, book and page where recorded): _____________________

 

Royalties, patents, copyrights: _______________________________

 

Annuities: (same information as on life insurance; is it a tax deferred annuity?)

 

Registered animals: (all information dealing with the registrar, and the animal which is

registered): _______________________________

 

Member of investment club: (all information concerning club,

ownership): _______________________________________________

 

Assets held in trust for another: (such as realtor's trust account for escrowed

funds): ________________________________________

 

Small business interests: (proprietorships, corporations, partnerships, LLC's, limited

partnerships) __________________________________

 

Registered coin collections: ___________________________________

 

Retirement benefits: (IRAs, Roth IRAs, §401k plans, SEPs, TSAs, §403b plans, Keogh plans, profit sharing plans, pension plans, and any other type of retirement plan) __________________________

 

The above checklist ought to give you an idea of what sort of information is needed before a trust can be funded. Not all of the assets will be placed in the trust, but death beneficiary designation forms will have to be prepared.

 

 

 

 

 

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