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Estate Planning Questionnaire

Estate Planning Questionnaire
  • Name of Husband:  

  • Name of Wife:  

  • Address:  

  • County:  

  • Residence Phone:  

  • Cell Phone:  

  • Work Phone:  

  • Email:  

  • Prior Marital History / Children:  

  • Number of Children:  

  • Child Name:  

  • Child Date of Birth:  

  • Child Name:  

  • Child Date of Birth:  

  • Child Name:  

  • Child Date of Birth:  

  • If Husband Survives, Outright to Husband:  

  • Family Trust (Husband Primary Benf/ Children secondary benf. and receive Principal upon husband's death):  

  • Other:  

  • Specific Bequests:  

  • If Wife Survives, Outright to Wife:  

  • Family Trust (Wife Primary Benf./ Children secondary benf and receive Principal upon wife's death):  

  • Other:  

  • Specific Bequests:  

  • UNDER AGE TRUST(S) - ( Allows for assets to be managed by Trustee until child / children reach a certain age(s) in the event both parents are deceased ) Children Under Age:  

  • Distribution Age(s):  

  • Guardian of Minor Children:  

  • County/State of Residence of Guardian of Minor Children:  

  • Second Guardian of Minor Children:  

  • Second County/State of Residence of Guardian of Minor Children:  

  • Husband's Executor:  

  • Address:  

  • Phone:  

  • Successor Executor:  

  • Address:  

  • Phone:  

  • Wife's Executor:  

  • Address:  

  • Phone:  

  • Successor Executor:  

  • Address:  

  • Phone:  

  • Trustee of Children's Trust:  

  • Address:  

  • Phone:  

  • Successor Trustee:  

  • Address:  

  • Phone:  

  • Husband's Durable Power of Attorney (Y or N):  

  • If Yes, Name:  

  • Address:  

  • County:  

  • Phone:  

  • Wife's Durable Power of Attorney (Y or N):  

  • If Yes, Name:  

  • Address:  

  • County:  

  • Phone:  

  • Medical Power of Attorney for Husband:  

  • Address:  

  • Phone:  

  • Second Medical Power of Attorney for Husband:  

  • Address:  

  • Phone:  

  • Medical Power of Attorney for Wife:  

  • Address:  

  • Phone:  

  • Second Medical Power of Attorney for Wife:  

  • Address:  

  • Phone:  

  • Directive to Physicians & Family Surrogates (Living Will) : Husband (Y or N):  

  • Directive to Physicians & Family Surrogates (Living Will) : Wife (Y or N):  

  • Gift by a Living Donor: Husband (Y or N):  

  • Gift by a Living Donor: Wife (Y or N):  

  • Contingent Beneficiaries ( in the event that all members of the family, i.e. Husband, Wife, Children do not survive each other):  

  • Please list approximate net value of combined estate and types of assets ( i.e. business, life insurance, retirement plans, etc. ) as this will help us in any other planning requirements:  


  • Please enter the security code below: