I have pasted below a standard estate planning questionnaire. I would be happy to email you an easier version to work with. Just send me an email and ask! I can send in Word or PDF as you prefer. -John
PRIVATE AND CONFIDENTIAL
LAW OFFICE OF
MEISSNER, JOSEPH & PALLEY, InC
JOHN B. PALLEY
Attorney at Law
Meissner, Joseph & Palley, INC.
1555 River Park Drive, Suite 108
Sacramento, CA 95815
2200 Douglas Blvd, Suite 150B
Roseville, CA 95661
PRIVATE AND CONFIDENTIAL
Before we begin the estate planning process, let us start by thanking you for selecting Johnson, Fort, Meissner, Joseph & Palley to prepare your estate planning documents. Even the most basic estate planning, to be effective, requires the attorney to analyze a lot of personal information. This includes information concerning your personal, family and financial status. We have prepared this form to aid you in organizing that information. However, do not think that this has to be completely filled out; this is not a test. This form is intended to get you thinking about the important issues related to estate planning.
When you come into our office we will discuss all of this and more, in a face-to-face manner. Please take your time filling this out, but do not procrastinate and put this at the bottom of the pile of things to do. This is important, easy to do, and relatively painless.
Also, please remember that you are not protected by an estate plan until the FINAL DRAFT IS COMPLETED, SIGNED, WITNESSED, AND NOTARIZED.
Once again, thank you for selecting Johnson, Fort, Meissner, Joseph & Palley to assist you with preparing your estate plan.
NOTICE OF CONFIDENTIALITY: AS IS TRUE WITH MOST COMMUNICATIONS BETWEEN LAWYER AND CLIENT, THE INFORMATION REPORTED HERE WILL BE HELD IN THE STRICTEST CONFIDENCE AND RELEASED TO NO ONE WITHOUT YOUR CONSENT.
FULLY CANDID ANSWERS ARE ESSENTIAL FOR COMPLETING THE ESTATE PLANNING PROCESS.
The Starting point of the estate planning process requires you to roughly calculate the size and nature of your estate assets. Please specify in the margin if the asset is “community property” (acquired during marriage) or “separate property” (acquired before marriage or inherited during marriage).
Total Annual Income of Household $ _____________
1) CASH AND SAVINGS (Please supply bank name, address and account number)
Checking Account $ ___________
Certificates of Deposit (CDs) $ ___________
Credit Union $ ___________
Savings Account $ ___________
Money Market $ ___________
TOTAL CASH AND SAVINGS $ ______________
2) MARKETABLE SECURITIES (Please include bank name, address and account number)
Stocks $ ___________
Bonds $ ___________
Mutual Funds $ ___________
Annuities $ ___________
Gold and Silver $ ___________
TOTAL OF MARKET SECURITIES $ ______________
3) REAL ESTATE (Please list address, city and state)
TYPE OF PROPERTY COUNTY MARKET VALUE – MORTGAGE = EQUITY
i. _______________________________ ______________________________________
ii. _______________________________ ______________________________________
iii. _______________________________ ______________________________________
TOTAL EQUITY IN REAL ESTATE $ _______________
4) FIXED AND OTHER ASSETS (Please supply additional information if available)
Business Interests $ ___________
Limited Partnerships $ ___________
Notes Due $ ___________
TOTAL OF FIXED AND OTHER $ ________________
5) RETIREMENT PLANS (Please bring bank name, address and account number)
IRA (Standard Deductible) $ ___________
IRA (Roth IRA) $ ___________
Keogh $ ___________
SEP $ ___________
401k $ ___________
403B $ ___________
Profit Sharing Plan $ ___________
TSA $ ___________
ESOP $ ___________
PASOP $ ___________
Deferred Compensation $ ___________
Pension Plan $ ___________
TOTAL OF RETIREMENT PLANS $ ________________
6) LIFE INSURANCE (Please list life insurance company and agent, if you know)
Face Value of Policy #1 $ ___________ (Term or Whole Life?)
Face Value of Policy #2 $ ___________ (Term or Whole Life?)
Face Value of Policy #3 $ ___________ (Term or Whole Life?)
TOTAL FACE AMOUNT OF LIFE INSURANCE $ ________________
7) OTHER ASSETS (Cars, boats, collectibles, etc.)
TOTAL OF OTHER ASSETS $ ________________
GRAND TOTAL OF ALL ASSETS $ ________________
The “will” is the foundation of any estate plan. No matter what size your estate is, a will is the backbone of that estate plan.
- 1. Your Preliminary Information (For ALL Estate Planning Clients to Fill out)
Your Full Name: _____________________________ Your Social Security: ______________
Your Date of Birth: ____________
Spouse’s Name: ___________________________ Spouse’s Social Security: ______________
Spouse’s Date of Birth: ____________
Phone(s): (H) __________________; (W) _________________(Other) _______________
Country of Citizenship: You ____________________ Spouse ___________________
What state were you legally married in: _______________
Include Other Names You have used: _________________________________________
Indicate Maiden Name, if applicable: ___________________
Name of Former Spouse: (1) _________________________(2) ___________________
Ended by Death or Divorce: (1) _____________________ (2) ____________________
Pre-Nuptial Agreement? Yes___ No___ (If yes, please attach copy)
2. NAMES AND PHONE NUMBERS OF YOUR FINANCIAL ADVISORS
Insurance Agent: ____________________________________
3. Burial Requests and Organ Donation
Do you have any special requests for burial (i.e. cremation or burial)?
Do you want to be an organ donor? Yes ___ No ____ Yes ___ No ____
Special Requests: _______________________________________________________________
4. Children (please indicate if child is deceased, adopted, step child, if from a prior
marriage, and if child is handicapped)
Name: DOB: Where born:
i)____________________________ ________ _______________
ii)____________________________ ________ _______________
iii)____________________________ ________ _______________
iv)____________________________ ________ _______________
Who do you want to have Custody of your Children? This is also known as the “Guardian”. Include alternate choices please. Although husband and wives are ok, please remember the possibility of death or divorce.
NAME CITY THEY RESIDE IN
i) ______________________ ___________________
ii) ______________________ ___________________
iii) ______________________ ___________________
iv) ______________________ ___________________
5. Beneficiary Selection
With the exception of establishing a guardian for any underage children, the beneficiary selection is the most crucial aspect of your estate plan. This is where you determine who gets what and how much they get. Although you should take extra time reading through this section, you will likely want to discuss these issues with me in a face to face meeting. Do your best, but don’t feel that everything has to be filled out completely.
You may want to begin by jotting down some general thoughts about who you want to get your property. The questions can help make these determinations more concrete. Consider if you die first and if your spouse dies first.
PERSONAL PROPERTY-General Gifts. Generally speaking, who do you want the bulk of your personal property (non-monetary or real property assets) such as paintings, collections, furniture, etc. to go to? You have the opportunity in the next question to leave specific items to other people. Feel free to have multiple people (i.e. all living children at your death) to share your personal property.
First Choice: _______________________________________________________________
Second Choice: _____________________________________________________________
Third Choice: ______________________________________________________________
Fourth Choice: _____________________________________________________________
PERSONAL PROPERTY- Specific Gifts. If you would like to make specific gifts of personal property, such as art, collectibles, etc., please list the items below and the recipients (with at least one successor person named, in case your first choice person is unable to take the gift). You can not list everything you own in a simple will; it is just not practical. The following items should be pieces of personal property that do not follow the general flow of your personal property (for example, maybe you want your special painting to go to your best friend rather than a spouse or child).
ITEM First Choice Second Choice
BULK OF PROPERTY. Who do you want to receive the bulk of your assets (money, real property, stocks, bonds, etc.) when you pass away? Feel free to divide up your estate in percentages (for example 30% to child 1, 30% to child 2, 30% to child 3, and 10% to your favorite niece). List back up choices; that is, if your primary beneficiaries are not alive who would you want to inherit your property? A person? A charity? If unsure, just jot down general notes.
Small gifts of Cash. In addition to the general flow of all your assets, is there anybody you would like to give a small cash gift to upon your death (i.e. $500 to a special niece or nephew)?
Charitable Gifts. Would you like to make any charitable contributions (which are tax deductible) upon your death? (Religious organizations, schools, fraternal organizations, and other such groups)
Disinheritance. Is there anybody you would like to specifically not give assets to at death?
1) ____________________________ 2) _______________________________
Trust Gifts. If we are establishing a trust for minor children, at what age(s) would you like disbursement to be made to the children without the trust restrictions? __________
If you are setting up a trust for you, and you are unable to serve as trustee and administer the affairs of the trust, who do you want to serve in the roll of trustee?
Can be the same as executor chosen below….
If unsure about the advantages and disadvantages of a trust, make sure we discuss it.
Also, if we are setting up a trust for you, we will talk in-depth about how they work, both before death and after death; so you fully understand what you are doing.
Who would you like to be Executor (or Personal Representative) of your will and estate upon your death? Their responsibility will be to distribute all of your personal property to the appropriate people and make sure the monetary assets either get to the people mentioned, or if you are also setting up a trust, that the assets get transferred to the trustee. Can choose the same people or you each can choose different people.
8. Other Inheritance Questions
1) Are you or your spouse beneficiaries or trustees of any trust? Yes No
2) Do you or your spouse have a power of appointment under any trust? Yes No
3) Do you or your spouse anticipate receiving an inheritance? Yes No
4) Have you ever filed (or had filed on your behalf) a gift tax return? Yes No
If yes to number 4, please bring copies.
5) Have interest in sole proprietorship, general partnership, limited
partnership or any closely held business? Yes No
6) Have you made gifts of over $10,000 to anybody in any year? Yes No
9. Do you have any special requests for your pets upon death?
Who To Take Care of them?
Any Money to go to caretakers? __________________________
OTHER ESTATE PLANNING DOCUMENTS
(Not optional, these are the ancillary documents necessary to complete an estate plan!)
- 10. Durable Power of Attorney for Financial Affairs
This document gives someone the power to make all sorts of financial decisions for you. These include, but are not limited to the following:
* Most all financial affairs
* Make Gifts
* Pay mortgage and other bills
* Conduct Banking
* Deal with Insurance
* Make Loans
* Operate Business
* Personal Care (Where you live, meals, take care of pets, handle mail, provide transportation, etc.)
This power will spring into effect when you are unable to handle your own affairs, as determined by a vote of 2 out of 3 named people in the document.
You should indicate your first choice, and successor choices, to hold your power of attorney. You can choose the same or choose different people:
- 11. Durable Power of Attorney for Health Care (“Living Will”)
This document is similar to the above, but allows someone to make health care related decisions for you. The powers are extensive, and include the ability to:
- Consent or refuse medical care
- Employ and Discharge Doctors
- Consent to or refuse life prolonging procedures
- Protect Right of Privacy
- Prevent pain
- Provide for companionship
This document is also called a “Living Will.” It tells the doctors what you want (or don’t want) in the way of life support. This means an incurable and irreversible condition that has been diagnosed by two physicians and:
– Will result in death within a relatively short time without administration of life- sustaining treatment; or
– Has produced an irreversible coma; or
– Persistent vegetative state.
Generally, I prepare the documents in a similar manner for most everybody. However, we can alter it for your needs if you desire something different. Generally, life support that is cut, if you are no longer able to make decisions regarding medical treatment, include:
– Food and water by artificial administration, even if would prolong life;
– Comfort care, even if would prolong life;
– All additional life-prolonging treatment be withheld, except for:
-Blood and blood products;
– Cardio-pulmonary resuscitation (CPR);
– Diagnostic tests;
Please initial here if you are in agreement with this ____________ ______________
You should indicate your first choice, and successor choices, to be your health care Agent. Can choose the same or different people:
13. Other Thoughts you have about your estate plan? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Thank you for taking the time to fill out this questionnaire. Please call us immediately to set up an appointment to discuss your answers and prepare your documents.
JOHNSON, FORT, MEISSNER, JOSEPH & PALLEY
1555 River Park Drive, Suite 108
Sacramento, CA 95815
BAY AREA/DOWNTOWN SACRAMENTO:
I -80 East Bound towards Reno. However, take the Business 80 transition when you get to Sacramento. Do not take I-80 towards RENO. Once on Business 80, exit at Arden Way. Stay in the right lane until you get to Point West. (Double Tree Hotel on right hand corner). Turn right at Point West (Elephant Bar Restaurant on corner). Take Point West to Response. Make a right turn on Response to River Park Drive. Turn right on River Park Drive.
I-80 W/B to Business 80 (CapitalCityFwy). Take the Capital City Fwy to theArdenexit. Stay in the middle turn lane. At the light, turn ontoArden Way. After you go under the Fwy, merge to far right lane. (Double Tree on right hand corner). Turn right at Point West (Elephant Bar Restaurant on corner). Take Point West to Response. Make a right turn on Response toRiver Park Drive. Turn right onRiver Park Drive.
RANCHO CORDOVA/EL DORADO HILLS:
Hwy 50 to theHowe Avenueexit. Make a right turn on Howe and take it toArden Way(several miles). Make a left turn atArden Way. TakeArdentoHeritage Lane. Make a left turn onto Heritage. Take Heritage to Response. Make a right turn on Response toRiver Park Drive. Turn right onRiver Park Drive.
LAW OFFICE OF
JOHNSON, FORT, MEISSNER, JOSEPH & PALLEY
FOR ATTORNEY TO FILL OUT
Referred By: _________________________________ Thank You Note Sent: _____
Written Fee Agreement Necessary? __________
Fee Range: $ __________
Conflict issue Discussed? __________
Letter Necessary? _________ Sent? ____ When: ___________
Appointment for Execution of Documents: ___________________________
Where: My Office Elsewhere ______________________
Documents to Prepare:
With Trust for kids _____
With Tax clause ____
With Guardianship _____
Pour Over _____
Durable Power of Attorney for Financial ____
Health Care Declaration (Living Will) _____
Advanced Trusts Necessary ______