CONFIDENTIAL ESTATE PLANNING QUESTIONNAIRE
Date: ______________________ Referred by:_______________________________
Phone: Home____________________ Work____________________ Cell__________________ Fax_________
Email: Personal__________________ Work____________________
Occupation:______________________________________ Resided in Florida since _____ Age_________
Have you ever made a will or a trust?______________ Safe deposit box is at__________________________ Bank
Citizen of U.S. ___; Other:_________ Accountant:_______________________________________
Life Insurance Agent:____________________________
Stock Broker: _____________________________________
FAMILY INFORMATION Name Address Phone Age
Brothers & Sisters
Persons Not Listed Above
Other Real Estate
Stocks, Bonds, Etc.
Bank, Savings, CD's,
IRA's, Retirement Accts, Etc.
(Please list to whom you want to leave your assets at your death. Please list alternates to receive each gift in case the person you name dies before you.)
Special gifts of jewelry, furnishings, autos, collections and other tangible property:
Gift of all remaining tangible property:
Gift of homestead:
Special gifts of cash, stock or other specific items:
Gift of all remaining assets (residue):
TRUSTS FOR MINORS OR OTHERS
List anyone (such as minor children) for whom you want assets held in trust instead of being distributed to them at your death, so that the trustee invests and distributes the assets on a certain schedule until the beneficiaries can do so alone?
Who do you want to be the trustee (may be bank or individual)?
List at what age you want the beneficiary to begin directly receiving income from the trust (e.g, age 21):
List at what age(s) you want the beneficiary to receive the principal (e.g., in thirds at ages 25, 30 and 35):
In addition to discussing your last will and testament...
Do you want to discuss the effect of holding assets in joint names or "in trust for" with others?
Do you want to discuss setting up a living trust?
Do you want to discuss giving someone your durable power of attorney to handle your financial affairs and bill paying?
Do you want to discuss signing a living will to express your desires concerning the use or non-use of medical procedures to prolong your life in case of terminal illness?
Do you want to discuss signing a designation of health care surrogate to give someone power to make medical decisions for you if you are unable to do so?
Do you want to discuss signing a declaration of preneed guardian in case a court finds you or your minor child incapacitated?
Do you want to discuss anything else? Please list: