Spouse 1 Full Name
Date of Birth
Phone Number
Email Address
Occupation and Employer
Do you have any prior marriages? (If yes please list ex-spouse’s name and what year you were divorced)
Spouse 2 Full Name
Date of Birth
Phone Number
Email Address
Occupation and Employer
Do you have any prior marriages? (If yes please list ex-spouse’s name and what year you were divorced)
Home Address
Do you own or rent your home?
Children: (Please indicate if a child is adopted) Name/Birth Date
Guardians for your minor children? (Full Name/ City and State of Residence)
Please list 3 people, in order of preference, who you would like to serve as Executor or Administrator of your estate. (Full Name/City and State of Residence) Personal Representative # 1 (SPOUSE 1):
Personal Representative # 2 (SPOUSE 1):
Personal Representative # 3 (SPOUSE 1):
Please list 3 people, in order of preference, who you would like to serve as Executor or Administrator of your estate. (Full Name/City and State of Residence) Personal Representative # 1 (SPOUSE 2):
Personal Representative # 2 (SPOUSE 2):
Personal Representative # 3 (SPOUSE 2):
Trustees: Please list 3 people, in order of preference, who you would choose to manage your assets in Trust for your Beneficiary. -Trustee #1 (Full Name/City and State
Trustee #2 (Full Name/City and State
Trustee #3 (Full Name/City and State
Name of Beneficiaries of your estate. - We will discuss Trust provisions to protect assets for minor/incapable beneficiaries during your Estate Planning meeting. (Full Name, Age of Person, and % or Dollar Amount)
Contingent Beneficiaries: the individuals or entities you would choose to inherit your estate in the unlikely event that none of your named beneficiaries survive you. (Full Name, City & State of Residence, % or Dollar Amount
Please list 3 people who you would choose to make legal and financial decisions for you if you were to become incapacitated or incapable of managing your own affairs. (Full Name, City and State of Residence) - Power of Attorney #1 (SPOUSE 1):
Power of Attorney # 2 (SPOUSE 1):
Power of Attorney # 3 (SPOUSE 1):
Please list 3 people who you would choose to make legal and financial decisions for you if you were to become incapacitated or incapable of managing your own affairs. (Full Name, City and State of Residence) - Power of Attorney # 1(SPOUSE 2):
Power of Attorney # 2 (SPOUSE 2):
Power of Attorney # 3 (SPOUSE 2):
Final Disposition: Please list 3 people who you would choose to be your personal representative with regards to your final remains. (Full Name, City & State of Residence) - Representative # 1 (SPOUSE 1):
Representative # 2 (SPOUSE 1):
Representative # 3 (SPOUSE 1):
Special Instructions Regarding Disposition (e.g. burial, cremation, etc.), Funeral and Memorial:
Final Disposition: Please list 3 people who you would choose to be your personal representative with regards to your final remains. (Full Name, City & State of Residence) Representative #1 (SPOUSE 2):
Representative # 2 (SPOUSE 2):
Representative # 3 (SPOUSE 2):
Special Instructions Regarding Disposition (e.g. burial, cremation, etc.), Funeral and Memorial:
Assets - Real Property (please list location, approximate value, and mortgage)
Assets - Cash and Liquid Accounts (checking, savings, CD’s, and money market accounts)
Assets - Life Insurance (please list type of policy, name of company, owner, and benefit amount)
Assets - Retirement and Investment Accounts (401k’s, IRA’s, Brokerage Accounts, Annuities, REITs, etc. and their approximate value)
Assets - Business Ownership (please list the names of any business that you own, please include the type of business, percentage of ownership, and approximate value of the business assets)
Assets - Expected Inheritances and Approximate Value (if any)
Name of Financial Advisor
Name of Accountant
Approximate Annual Income
Who can we thank for referring you to our office?
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