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Estate Planning Questionnaire
Estate Planning Questionnaire
Section 1: Personal Information
Marital Status
(Required)
Married
Separated
Divorced
Widowed
Single
Date of marriage
(Required)
MM slash DD slash YYYY
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Other
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Spouse A
Please fill out "Spouse A's" information in this section
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Other
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Spouse B
Please fill out "Spouse B's" information in this section
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(If different than the address listed for Spouse A)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Section 2: Children and Other Family Members
How many children and other family members will be considered in your estate?
(Required)
Please enter a number less than or equal to
20
.
1. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
2. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
3. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
4. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
5. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
6. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
7. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
8. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
9. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
10. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
11. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
Section 3: Pets
Do you have any pets?
(Required)
Yes
No
Other
Do you wish to provide for the care of your pets in the event of your incapacity or death?
(Required)
Yes
No
Other
How many pets do you have?
(Required)
Section 4: Estate Considerations
Please rate the following as to how important they are to you.
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting children.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting grandchildren.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Disinheriting a family member.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for charities at the time of death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for the transfer and survival of a family business.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding or reducing your estate taxes.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding probate.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Reduce administration costs at time of your death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding a conservatorship (“living probate”) in case of a disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding will contests or other disputes upon death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Protecting assets from lawsuits or creditors.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for a child with disabilities or special needs, such as medical or learning disabilities.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Provide that your death shall not be unnecessarily prolonged by artificial means or measures.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Other Concerns
Please list
Spouse A
Please indicate the level of concern Spouse A has for the matters listed below
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting a spouse.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting children.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting grandchildren.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Disinheriting a family member.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for charities at the time of death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for the transfer and survival of a family business.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding or reducing your estate taxes.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding probate.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Reduce administration costs at time of your death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding a conservatorship (“living probate”) in case of a disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding will contests or other disputes upon death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Protecting assets from lawsuits or creditors.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for a child with disabilities or special needs, such as medical or learning disabilities.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Provide that your death shall not be unnecessarily prolonged by artificial means or measures.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Other Concerns
Please list
Spouse B
Please indicate the level of concern Spouse B has for the matters listed below
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting a spouse.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting children.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting grandchildren.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Disinheriting a family member.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for charities at the time of death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for the transfer and survival of a family business.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding or reducing your estate taxes.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding probate.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Reduce administration costs at time of your death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding a conservatorship (“living probate”) in case of a disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding will contests or other disputes upon death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Protecting assets from lawsuits or creditors.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for a child with disabilities or special needs, such as medical or learning disabilities.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Provide that your death shall not be unnecessarily prolonged by artificial means or measures.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Other Concerns
Please list
Section 5: Family Questions
Are you (or your spouse) receiving Social Security, disability, or other governmental benefits?
(Required)
Yes
No
Please Describe
Are you (or your spouse) making payments pursuant to a divorce or property settlement order?
(Required)
Yes
No
If married, have you and your spouse signed a pre- or post-marriage contract?
(Required)
Yes
No
N/A
Have you (or your spouse) been widowed?
(Required)
Yes
No
Have you (or your spouse) ever filed federal or state gift tax returns?
(Required)
Yes
No
Have you (or your spouse) completed previous will, trust, or estate planning?
(Required)
Yes
No
Do you support any charitable organizations now that you wish to make provisions for at the time of your death?
(Required)
Yes
No
Please explain
Are there any other charitable organizations you wish to make provisions for at the time of your death?
(Required)
Yes
No
Please explain
If married, have you lived in any of the following states while married to each other? Arizona, California, Idaho, Louisiana, Nevada, Texas, Washington, or Wisconsin
(Required)
Yes
No
N/A
Are you (or your spouse) currently the beneficiary of anyone else’s trust?
(Required)
Yes
No
Please explain
Do any of your children have special educational, medical, or physical needs?
(Required)
Yes
No
N/A
Do any of your children receive governmental support or benefits?
(Required)
Yes
No
N/A
Do you provide primary or other major financial support to adult children or others?
(Required)
Yes
No
N/A
Additional Information
Section 6: Property Information
What assets do you own?
(Required)
Real Estate
Furniture and Personal Effects
Automobiles, Boats, and/or RVs
Bank and Savings Accounts
Stocks and Bonds
Life Insurance and Annuities
Retirement Accounts
Business Interests
Money owed to you
Anticipated Inheritance, Etc.
Other Assets
Knowing how you own your property is essential for the purpose of properly designing and implementing your estate plan. Please list your property below. For each property, indicate (in the ownership column) how the property is titled.
Instructions for completing the Property Information Checklist
Please use the following "
owner
" designations
C
= Client (you) alone own the property, if single
A
= Spouse A alone owns the property
B
= Spouse B alone owns the property
AB
= Spouse A and Spouse B own the property jointly
AO
= The property is owned in Joint Tenancy by Spouse A and someone other than Spouse B
BO
= The property is owned in Joint Tenancy by Spouse B and someone other than Spouse A
?
= If you do not know how the property is owned
Summary of Value : Real Estate
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Furniture & Personal Effects
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Automobiles, Boats, & RVs
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Bank & Savings Accounts
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Stocks & Bonds
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Life Insurance & Annuities
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Retirement Accounts
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Business Interests
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Money Owed to You
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Anticipated Inheritance, Etc.
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Summary of Value : Other Assets
(Required)
Please indicate the value of the property that Spouse A and Spouse B own. For joint property (AB), enter 1/2 of the value in each spouse's column
Asset
Ownership
Spouse A
Spouse B
Total Value
Add
Remove
Please list your assets and their value below.
Summary of Value : Real Estate
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Furniture & Personal Effects
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Automobiles, Boats, & RVs
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Bank & Savings Accounts
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Stocks & Bonds
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Life Insurance & Annuities
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Retirement Accounts
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Business Interests
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Money Owed to You
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Anticipated Inheritance, Etc.
(Required)
Asset
Total Value
Add
Remove
Summary of Value : Other Assets
(Required)
Asset
Total Value
Add
Remove
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Referred by:
(Required)
(Optional) Upload Files
Drop files here or
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Max. file size: 256 MB.
CAPTCHA
Estate Planning Questionnaire
Section 1: Personal Information
Marital Status
(Required)
Married
Separated
Divorced
Widowed
Single
Date of marriage
(Required)
MM slash DD slash YYYY
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Other
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Spouse A
Please fill out “Spouse A’s” information in this section
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Other
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Spouse B
Please fill out “Spouse B’s” information in this section
Legal Name
(Required)
(Name most often used to title property and accounts)
First
Last
Also Known As
(Other names used to title property and accounts)
Date of Birth
(Required)
MM slash DD slash YYYY
Social Security Number
Phone
(Required)
Do we have permission to text you at this number?
(Required)
Yes
No
Email
(Required)
(Please provide an email at which you can receive communication from the firm)
Home Address
(If different than the address listed for Spouse A)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a US Citizen?
(Required)
Yes
No
Other
Employment Status
(Required)
Employed
Self-Employed
Unemployed
Retired
Employer
(Required)
Job Title
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Annual Income
(Required)
Section 2: Children and Other Family Members
How many children and other family members will be considered in your estate?
(Required)
Please enter a number less than or equal to
20
.
1. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
2. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
3. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
4. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
5. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
6. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
7. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
8. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
9. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
10. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
11. Child / Family Member
Legal Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Relationship
(Required)
Does this person live with you?
(Required)
Yes
No
Related to which party?
(Required)
Spouse A
Spouse B
Both
Neither
Section 3: Pets
Do you have any pets?
(Required)
Yes
No
Other
Do you wish to provide for the care of your pets in the event of your incapacity or death?
(Required)
Yes
No
Other
How many pets do you have?
(Required)
Section 4: Estate Considerations
Please rate the following as to how important they are to you.
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting children.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for and protecting grandchildren.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Disinheriting a family member.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Providing for charities at the time of death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Plan for the transfer and survival of a family business.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding or reducing your estate taxes.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding probate.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Reduce administration costs at time of your death.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding a conservatorship (“living probate”) in case of a disability.
(Required)
High Concern
Some Concern
Low Concern
No Concern / Not Applicable
Avoiding will contests or other disputes upon death.
(Required)
