Kraft Walser
Hettig & Honsey
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ESTATE PLANNING INTAKE FORM
(Please print and fill out this form)
This form completely is optional and if you don't want to complete it all, that's OK. It simply gives you guidance on what will be discussed.
We will rely upon this information you provide us to be accurate and complete in all respects. If the information is not accurate and complete, the recommendations we make may not be appropriate for your situation.
1. Person(s) making will
Name__________________________________Date of Birth_________Social Security No.________________
U.S. Citizen? Yes__No__
Spouse Name____________________________Date of Birth_________Social Security No.________________
U.S. Citizen? Yes__No__
Street Address______________________________Apt___County__________________________________
City____________________________State________________Zip Code__________________________
State of Residence___ Telephone #__________________W/Client________W/Spouse___________
Email Address___________________________________________
2. Marriage
a. Have you and your spouse signed a
Premarital Agreement? Yes___No___ If you have, please bring a copy
of it
to the interview.
b. Have you or your spouse been
divorced? Yes___No___ If so, please bring a copy of the divorce
decree
to the interview.
3. Children
Please list ALL your children,
including deceased children, children born out of wedlock, and children you
wish to omit from your estate plan.
| Name of Child | Date of Birth | Address | Child of |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
| . | . | . | . |
Identify any child who is not a natural or adopted child of both you and your spouse.
____________________________________________________________________________________
____________________________________________________________________________________
a. Have any children received an advance on their inheritance or are any children financially indebted to you?
If so, Please explain__________________________________________________________________
_________________________________________________________________________________
b. Is there any reason NOT to treat your children equally? If so, please explain_______________________
_________________________________________________________________________________
c. Are any of the children under a disability?___________________________________________________
__________________________________________________________________________________
d. Do you have any special concerns or objectives regarding your children? ___________________________
____________________________________________________________________________________
e. Guardians. Who should be guardian
of your minor children? (a guardian has physical and legal control over
your children until they reach the age of 18)
Name:______________________________________________________________________________
Address:____________________________________________________________________________
Alternate Guardian:_____________________________________________________________________
4. Personal Representative.
Who should be Personal Representative ("executor") of your estate?
A personal
Representative is responsible for probating your will,
paying your debts, collecting your assets and settling your
estate.
Name:________________________________Relationship to you:_______________________________
Address:____________________________________________________________________________
Alternate Personal Representative:_________________________Relationship to you:_________________
Address:____________________________________________________________________________
5. Trusts
If a trust is appropriate to include in your estate plan,
who should be the trustee? A trustee is the person or entity
who is responsible for managing the assets placed into
the trust. A trustee manages the assets for your children
or other beneficiaries until they reach specified
ages. If you do not establish a trust, children inherit at age 18.
You may name an individual, bank or trust company, or
both to act as your trustee.
Name:_________________________________________________________________________________
Address:_______________________________________________________________________________
Alternate Trustee:________________________________________________________________________
Address:_______________________________________________________________________________
6. Financial Inventory
Use approximate values under each person showing
ownership of each asset. PLEASE BRING SUPPORTING
DATA FOR EACH ASSET, i.e. bank statements, retirement
reports, stock and bond account reports, etc.
NOTE: If you are entering into a revocable (living)
trust, please bring copies of deeds to the real estate you own.
| Assets | Name of Bank Holding Account | Husband | Wife | Joint |
| Checking Account | . | $ | $ | $ |
| Savings Account | . | $ | $ | $ |
| Money Market Acct. | . | $ | $ | $ |
| Stocks & Bonds | . | $ | $ | $ |
| Closely Held Business Interest | . | $ | $ | $ |
| Life Insurance (Face) | . | $ | $ | $ |
| On Husband's life | . | $ | $ | $ |
| On Wife's life | . | $ | $ | $ |
| Retirement Accounts | . | $ | $ | $ |
| IRA | . | $ | $ | $ |
| Pension | . | $ | $ | $ |
| Profit Sharing/401K | . | $ | $ | $ |
| Home | . | $ | $ | $ |
| Other Real Estate | . | $ | $ | $ |
| Automobile | . | $ | $ | $ |
| Personal Property | . | $ | $ | $ |
| Other Assets | . | $ | $ | $ |
| . | , | $ | $ | $ |
| Total | . | $ | $ | $ |
| Liabilities | Name of Company | Husband | Wife | Joint |
| Home Mortgage | . | $ | $ | $ |
| Other Mortgages | . | $ | $ | $ |
| Debts to Family Members | . | $ | $ | $ |
| Other Debts (describe) | . | $ | $ | $ |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| Total Liabilities | . | $ | $ | $ |
7. Beneficiary Designations
a.
| Policy Name/Number | Face Value | Owner | Insured | Beneficiary |
| 1. | $ | . | . | . |
| 2. | $ | . | . | . |
| 3. | $ | . | . | . |
| 4. | $ | . | . | . |
| 5. | $ | . | . | . |
b. Retirement Plans. Please list your retirement plans/IRA's; value of each and the beneficiary of each.
| Company/Bank | Value | Beneficiary |
| . | $ | . |
| . | $ | . |
| . | $ | . |
| . | $ | . |
| . | $ | . |
| . | $ | . |
c. Does your retirement plan have a death benefit? Yes__No__ If so, who is the named beneficiary?
_____________________________________________________________________________________
8. Personal Property
Describe and
give a value of any items of substantial value, such as automobiles, works
of art, jewelry, etc. Be
sure to include any items listed on an insurance rider.
| Description | Approximate Value |
| Personal Property | . |
| Automobiles | . |
| Collectibles | . |
| Jewelry | . |
| Boats/Airplanes | . |
| Other | . |
| . | . |
| . | . |
| . | . |
| . | . |
| . | . |
9. Safe Deposit Box
Do you have a safe deposit box? Yes___No___ If so, where?_____________________________________
Does anyone else have access to your box? ___________________________________________________
10. Future Inheritances
Do
you expect any inheritance in the near future? If so please give
details____________________________
___________________________________________________________________________________
____________________________________________________________________________________
11. Financial Advisors
Accountant__________________________________________________________________________
Address_________________________________________________Telephone____________________
Financial Advisor______________________________________________________________________
Address_________________________________________________Telephone____________________
12. Special Requests
Special requests regarding funeral, cremation, or burial instructions are best handled by a Letter of Instruction or other statement (see separate from your will) to your family or other responsible person. Organ donation is best handled in a Health Care Directive and noted on the person's drivers license.