Estate Planning Questionnaire

"*" indicates required fields

Step 1 of 12

Client Information

Please fill in the form below or CLICK HERE to download and complete the form offline.

Full Legal Name*

First Middle Last

Select if you have the following:

Previously used legal names

Other used names

List all previously used legal names:

List all previously used names:

Email*

Date of Birth*

Month

Day

Year

Social Security Number (optional)

Home Phone Number*

Cell Phone Number

Work Phone Number

U.S. Citizen*

Yes

Florida or Texas Resident*

Florida

Texas

Other

Do you claim Florida Homstead Exemption?*

Yes

Unsure

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Place of Birth*

City State / Province / Region Country

What County do you live in?*

Occupation*

Employer*

Marital Status*

Single

Married

Divorced

Separated

Widowed

Marital History*

Have you ever been divorced or widowed?

Yes

Do you have any children?*

Yes - Age of Majority

Yes - Minor

Yes - Age of Majority & Minor

Family Information

Spouse

Please state the date and place of your marriage, and the legal name and birth date of your spouse:

Spouse Name*

First Middle Last

Spouse Date of Birth*

Month

Day

Year

Place of Marriage*

City State / Province / Region Country

Date of Marriage*

Month

Day

Year

Did you enter into a "pre-nuptial" or "post-nuptial" agreement?*

Yes

Please upload a copy of the agreement.

Max. file size: 32 MB.

Have you ever lived in Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin while you were married?*

Yes

Did you purchase a home or other real property in that state?*

Yes

Spouse Information

There is no information required. Please proceed to the next page.

Family Information Continued

Has any child predeceased you?*

Yes

Did that child have any children?*

Yes

Do you have any illegitimate children?*

Yes

Are you including posthumous/after born children?*

Yes

Children Information

Do not include step children or foster children who live with you.

Number of Children

Please enter a number from 1 to 10.

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Full Legal Name*

First Middle Last

Date of Birth*

Month

Day

Year

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Children (i.e. your grandchildren)*

Number of Children (i.e. your grandchildren)

Fiduciaries

Personal Representative

Whom do you want to nominate as the “personal representative” (i.e., the executor) of your estate? Married persons often select their spouse. Please note that under Florida law, if the personal representative is not related to you, he or she must be a Florida resident. You may also select “joint” personal representatives or a “corporate” personal representative (e.g., bank or trust company).

Do you want to assign a personal representative?

Yes

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alternate Personal Representative

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Some probate judges will allow the personal representative to serve without having to post a bond if the decedent’s will waives the bond requirement. Other judges refuse to allow a waiver because of concerns about protecting estate creditors and beneficiaries from misfeasance or nonfeasance. Do you want your personal representative or alternate to be required post a bond (which is paid by your estate) to be able to serve?*

Yes

Trustees

If you are considering establishing a trust during your life or after your death for a spouse, child, grandchild, parent or another person or charity (especially to avoid payment of large sums of money to a beneficiary at one time, or prior to a beneficiary attaining a certain age, or for a specific purpose), whom do you want to nominate as the trustee? You may also select “cotrustees”or a “corporate” trustee (e.g., bank or trust company).

Do you want to assign a trustee?

Yes

Successor Trustee

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alternate Trustee

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guardians

If you have any children who are minors, a guardian should be named in your will to care for their person and to manage their property until they attain 18 years of age in the event of the death of both parents. You may nominate “joint” guardians. You may also nominate separate guardians for a child, that is, a “guardian of the person” and a “guardian of the property” especially if a proposed guardian may not be suitable for handling a child's property and finances. A guardian of the property could include a “corporate” guardian or corporate co-guardian. Please note that under Florida law, if the person you nominate as guardian is not related to the child, he or she must be a Florida resident to be appointed.

Primary Guardian

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alternate Guardian

Full Legal Name*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guardian Information

There is no information required. Please proceed to the next page.

Specific bequests

List any specific items (e.g., automobiles, jewelry, personal effects, etc.) or specific amounts of money that you wish to leave to one or more beneficiaries. If you have a large number of items of “tangible personal property” that you want to give to several persons, you may want to consider having a “separate writing” prepared. If this is true, or you need more than 4, then enter 0 in the field.

Number of bequests*

Please enter a number from 0 to 4.

Item of Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Item of Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Item of Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Item of Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If a beneficiary of a specific bequest does not survive you, state who is to receive his or her share (e.g., the children of that beneficiary or one or more other persons).*

Would you like to assign any residue?

After paying expenses of administration and any debts and taxes, and after distributing any specific bequests, a residue may remain. State who should receive the residue and in what amount or percent.

Yes

Residue

Percentage or Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Percentage or Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Percentage or Amount*

Name of Beneficiary*

First Middle Last

Relationship to you*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If a residuary beneficiary does not survive you, state who is to receive his or her share (e.g., the children of that beneficiary or one or more other persons).*

Trusts

If you are considering establishing one or more trusts during your life or after your death, describe some of the general provisions you think are important.

Use this space to provide any additional information concerning your testamentary intentions.

Miscellaneous

Do you have a “will” or “revocable living trust”?*

Yes

Please attach a copy.

Max. file size: 32 MB.

Do you have a “durable power of attorney”?*

Yes

Please attach a copy.

Max. file size: 32 MB.

Do you have any “living will documents”?*

Yes

Please attach a copy.

Max. file size: 32 MB.

Are any organs to be donated after your death?*

Yes

List the specific organs and any limitations of their use*

For any, state "allow any usable" For any purpose, state "allow any purpose"

Is there a specific disposition of your remains?*

Yes

Please specify the disposition*

Do you want to assign a durable power or attorney?*

Yes

Agent Information

Full Legal Name*

First Middle Last

Relationship to you*

Social Security Number (optional)*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Effective date of power*

Month

Day

Year

Note: Florida law currently only allows for an immediate power of attorney)

Do you have any living will documents?*

i.e., documents authorizing another person to carry out your wishes in the event you are unable to communicate your decisions concerning extending, withholding or withdrawing life-prolonging procedures under certain legally permissible circumstances.

Yes

Health Care Surrogate

Full Legal Name*

First Middle Last

Relationship to you*

Home Phone*

Cell Phone

Work Phone

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alternative Health care surrogate

Full Legal Name*

First Middle Last

Relationship to you*

Home Phone*

Cell Phone

Work Phone

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your primary physician

Name*

First Last

Office Phone*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Summary of Assets and Liabilities

The following is a financial summary for estate and tax planning purposes. Further detailed information and copies of documents concerning particular assets and liabilities may be requested. In lieu of completing this summary, you may substitute a current financial statement.

Personal income in USD$*

Significant Other income in USD$

Click Here to download and complete the Summary of Assets and Liabilities document.

Please attach the Summary of Assets and Liabilities document.

Max. file size: 32 MB.

Life Insurance

How many life insurance policies do you hold?*

Please enter a number from 0 to 5.

Amount of Death Benefit*

Policy Type*

Owner*

Company*

Please provide more details about your type of life insurance policy.*

Amount of Death Benefit*

Policy Type*

Owner*

Company*

Please provide more details about your type of life insurance policy.*

Amount of Death Benefit*

Policy Type*

Owner*

Company*

Please provide more details about your type of life insurance policy.*

Amount of Death Benefit*

Policy Type*

Owner*

Company*

Please provide more details about your type of life insurance policy.*

Amount of Death Benefit*

Policy Type*

Owner*

Company*

Please provide more details about your type of life insurance policy.*

Please select if you retain any of the following:

Accountant

Banker

Financial Planner

Investment Broker

Life Insurance Agent

Accountant Name*

First Last

Accountant Phone*

Accountant Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Banker Name*

First Last

Banker Phone*

Banker Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Financial Planner Name*

First Last

Financial Planner Phone*

Financial Planner Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Investment Broker Name*

First Last

Investment Broker Phone*

Investment Broker Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Life Insurance Agent Name*

First Last

Life Insurance Agent Phone*

Life Insurance Agent Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Completed*

Month

Day

Year

Consent*

I certify all the provided information is true.

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Whom may I thank for the referral?

Name

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