Estate Plan Design Questionnaire Please make sure you and your spouse each complete your own questionnaire. "*" indicates required fields NameThis field is for validation purposes and should be left unchanged.Your Name* First Last Successor Trustee(s)*You OR you and your spouse will be the initial trustees of the trust we create. Who would you like to act as a successor (or backup) trustee if you are no longer able to act as the trustee? Please list 2 or 3 names and include their addresses and phone numbers.NameAddressPhone Add RemoveWill Executor(s)*The executor is named in your will as the person responsible for making legal decisions on behalf of your estate. If applicable, the first person is usually your spouse. It's a good idea to list one or two additional names after your spouse. Please include addresses and phone numbers.NameAddressPhone Add RemoveHealth Care Agent(s)*Who do you wish to make health care decisions for you in the event you are no longer able to do so for yourself. If applicable, your spouse is usually the default answer. It's a good idea to list one or two additional names after your spouse in case of an emergency. Please include addresses and phone numbersNameAddressPhone Add RemoveFinancial Agent(s)*Who do you wish to make financial decisions for you in the event you are no longer able to do so for yourself. If applicable, your spouse is usually the default answer. It's a good idea to list one or two additional names after your spouse in case of an emergency. Please include addresses and phone numbers.NameAddressPhone Add RemoveEstate Beneficiaries*If your spouse pre-deceases you, who would you like to give the assets of your estate to? Please list the beneficiaries name and gift percentage. Common beneficiaries include: Children, grandchildren, relatives, friends, non-profits, religious organizations.NameGift Percentage Add RemoveAssetsRetirement Assets*Please provide a Brief and Estimated list of your retirement accounts (including 401Ks, IRAs, Roth IRAs, etc.) List: 1) The account, 2) Estimated amount and 3) the current beneficiary.Account NameEstimated AmountCurrent Beneficiary Add RemoveInvestment Assets*Please provide a Brief and Estimated list of your investment accounts (including stocks, bonds, mutual funds, etc) List: 1) The account, 2) Estimated amount and 3) the current beneficiary.Account NameEstimated AmountCurrent Beneficiary Add RemoveBank Accounts*Please provide a Brief and Estimated list of your bank accounts List: 1) The account, 2) Estimated amount and 3) is there a co-owner or a transfer on death established?Account NameEstimated AmountCo-Owner or Transfer on Death Add RemoveLife Insurance*Please list any life insurance policies you may have. What is the amount? and who is the beneficiary?Account NameAmountBeneficiary Add RemoveReal Estate*Please list the address(es) of your principal residence and any other real estate you own.AddressType (principal, vacation, other) Add RemoveAdditional InformationPotential Inheritance*Do you anticipate receiving any possible inheritance from family or loved ones in the near future? Yes No Inheritance DetailsPlease provide additional information as to source and estimated amount.Business Owner*Are you an owner or co-owner of a business? Yes No Business DetailsPlease provide additional information related to your business ownership.Other AssetsAre there any other assets we haven't mentioned that you'd like us to know about?Anything Else?Is there anything else you'd like us to know about?
