Estate Planning Questionnaire

Please complete all applicable sections. Your information is kept strictly confidential.

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1 Personal Information

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Client 1
Client 2 (Spouse / Partner)
Marital Information

Do you want your spouse to be the primary agent for all roles — including Guardian, Executor, Trustee, Financial Power of Attorney, and Healthcare Power of Attorney?

Prior Marriages

2 Children & Dependents

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Children
Other Dependents

3 Existing Documents

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Check all documents you currently have in place:

4 Assets

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Real Estate
Property Description / AddressTitle Held AsEst. ValueMortgage Balance
Bank & Cash Accounts
InstitutionAccount TypeTitle/OwnerApprox. Balance
Investment & Brokerage Accounts
InstitutionAccount TypeTitle/OwnerApprox. Value
Retirement Accounts
InstitutionType (401k, IRA, etc.)OwnerBeneficiaryApprox. Value
Life Insurance
CompanyType (Term/Whole/Univ.)InsuredBeneficiaryDeath Benefit
Business Interests
Business NameEntity Type% OwnershipEst. Value
Other Significant Assets
DescriptionTitle/OwnerEst. Value

5 Liabilities

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CreditorType (Mortgage, Auto, Student, etc.)Balance OwedMonthly Payment

6 Distribution of Estate

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Primary Beneficiaries
Contingent Beneficiaries
Specific Gifts
Gift DescriptionRecipient NameRelationship
Charitable Giving
Organization NameAmount / %Notes

7 Guardianship

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If you have minor children, who would you like to serve as guardian?

Based on your selection, your spouse is designated as the Primary Guardian. Please provide your alternate choices below.
★ Primary Guardian: Spouse (see Section 1)
Primary Guardian
Alternate Guardian
Separate Financial Guardian?
Financial Guardian

8 Fiduciaries

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Designate individuals to serve in the following roles.

Executor / Personal Representative
Based on your selection, your spouse is designated as the Primary Executor. Please provide your alternate choices below.
★ Primary Executor: Spouse (see Section 1)
Trustee
Based on your selection, your spouse is designated as the Primary Trustee. Please provide your alternate choices below.
★ Primary Trustee: Spouse (see Section 1)
Financial Power of Attorney
Based on your selection, your spouse is designated as the Primary Financial POA. Please provide your alternate choices below.
★ Primary Financial POA: Spouse (see Section 1)
Healthcare Power of Attorney
Based on your selection, your spouse is designated as the Primary Healthcare POA. Please provide your alternate choices below.
★ Primary Healthcare POA: Spouse (see Section 1)

9 Healthcare & End-of-Life

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10 Digital Assets

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List significant digital assets, accounts, or online presence.

Account / PlatformType (Financial, Social, Email, etc.)Instructions / Notes

11 Special Circumstances

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12 Goals & Signature

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Disclaimer: This questionnaire is for informational purposes to assist in the preparation of your estate plan. Completing this form does not establish an attorney-client relationship. All information provided will be kept strictly confidential. Please consult with a qualified estate planning attorney before making any legal decisions.