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Estate Planning Questionnaire
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The following document is the Estate Planning Questionnaire used by our firm. All information you provide in this questionnaire will remain confidential. The following questions are designed to help you think about your goals and objectives with regard to planning your estate. The questions will help us identify the areas you wish to concentrate on, as well as serve for the backbone from which your plan will be developed.

If there are any questions on the pages that follow which you are uncomfortable answering, please leave them blank. However, the more information we have from you, the better able we will be to serve you, and determine which concepts are most appropriate. Some questions may not be applicable to you. Please mark those questions "N/A".

If you have any questions when completing this document please do not hesitate to contact us.

Once all fields are complete, please click the "Submit" button.


Client Information
Name
Citizenship
Date of Birth
Spouse Information (If Applicable)
Name
Citizenship
Date of Birth
Child 1 Information (If Applicable)
Name
Citizenship
Date of Birth
Child 2 Information (If Applicable)
Name
Citizenship
Date of Birth
Child 3 Information (If Applicable)
Name
Citizenship
Date of Birth
Child 4 Information (If Applicable)
Name
Citizenship
Date of Birth
Other Dependants

If you have other dependants, please state their names and the nature of the relationship.
Contact Information
Home Address
Phone Number
Fax Number (optional)
Email Address
Client Business Information (If Applicable)
Business Address
Years at Employment
Years to Retirement
Phone Number
Fax Number
Email Address
Spouse Business Information (If Applicable)
Business Address
Years at Employment
Years to Retirement
Phone Number
Fax Number
Email Address
Questions for Client
Have you ever entered into a prenuptial or postnuptial agreement?
Have you ever executed a will or trust?
Have you ever executed a Durable Power of Attorney?
Have you ever executed a Health Care Proxy or Health Care Directive?

If yes to any of these questions, we will require a copy of the relevant documents.

Questions for Spouse (If Applicable)
Have you ever entered into a prenuptial or postnuptial agreement?
Have you ever executed a will or trust?
Have you ever executed a Durable Power of Attorney?
Have you ever executed a Health Care Proxy or Health Care Directive?

If yes to any of these questions, we will require a copy of the relevant documents.

Questions for Both Client and Spouse

Please state your parents' and siblings' names and indicate whether alive or deceased; indicate general health of living parent(s)

Parent or Sibling #1 (If Applicable)
Name
Relationship
Alive/Deceased
Parent or Sibling #2 (If Applicable)
Name
Relationship
Alive/Deceased
Parent or Sibling #3 (If Applicable)
Name
Relationship
Alive/Deceased
Parent or Sibling #4 (If Applicable)
Name
Relationship
Alive/Deceased
Parent or Sibling #5 (If Applicable)
Name
Relationship
Alive/Deceased
Parent or Sibling #6 (If Applicable)
Name
Relationship
Alive/Deceased
General Information
State whether or not you have a regular affiliation with a house of worship and if so, its name and town.
State if you have a regular physician and the date of your last check up. Please indicate the physician's name and address. State any physical disabilities or chronic conditions.
State if you are currently or have ever been treated for a mental disease or disorder. Please indicate the dates and the psychiatrist/psychologist/counselor's name and address.
Please state where you keep important documents including wills, tax returns, birth certificate, etc.
Educational Background

Please state succinctly your educational statistics, including the names of any and all schools attended by you and dates. This should include grammar, junior and senior high schools, college, graduate and postgraduate instructions.

Client's Schools
Grammar School and Dates
Junior High School and Dates
High School and Dates
College and Dates
Postgraduate and Dates
Other schools:
Spouse's Schools
Grammar School and Dates
Junior High School and Dates
High School and Dates
College and Dates
Postgraduate and Dates
Other schools:
Please succinctly state any military history or federal civilian service if applicable, including branch of service, disabilities and any benefits currently due or anticipated.
Please state your marital history if applicable. Include age of current, former or deceased spouse, date and place of marriage, spouse's employment status and health. Give information for each marriage if more than one. When previous marriage was terminated, give the date and place of the termination describe the nature of the termination: death, divorce, annulment.
Family burial plot - if you have one, please state location and who holds title.
Safe deposit box - please identify location, number and and the individuals with access and location of key.
Are you a beneficiary of a trust?
Are you expecting a bequest under another's estate imminently?
If you have children under the age of 18, please consider the name(s) of persons whom you would nominate to be guardians upon the predecease of both parents. Your initial thoughts noted here can be discussed later.
Please consider the person(s) or institutions that you would select to be the personal representative (the executor) of your estate. This person need not be a lawyer and need not be a relative. You should feel comfortable with the executor knowing and becoming involved with the intimate details of your financial matters. You should trust the executor in dealing with household effects and possessions. Consider the age and health of the person. Nominees need not be asked for consent, although it is usually a good idea. List an alternative in case the primary predeceases or is unable or unwilling to act. Your initial thoughts noted here can be discussed later.
Consider the following wishes:
Funeral and Burial Instructions
Power of attorney. If yes, whom? Alternate?
Health care proxy. If yes, whom? Alternate?
List any specific bequests of real estate, personal property, cash, etc. you wish to make, whether to individuals, organizations, or charities.
Do you have any other questions that have occurred to you during the preparation of this worksheet that you want to discuss prior to the drafting your estate planning documents?
Real Property

Please use this section to fill out any real estate owned by either client, spouse, or both.

Property #1
Description
Owner
Value
Mortgate
Property #2
Description
Owner
Value
Mortgate
Property #3
Description
Owner
Value
Mortgate
Property #4
Description
Owner
Value
Mortgate
Property #5
Description
Owner
Value
Mortgate
Other property:
Investments

Please use this section and complete for any NON RETIREMENT investment accounts. Do not enter information about 401k, IRAs, Annuities, or life insurance in this section. Do list such accounts as non retirement investment accounts, money market accounts, checking or savings accounts.

Investment #1
Description
Owner
Value
Investment #2
Description
Owner
Value
Investment #3
Description
Owner
Value
Investment #4
Description
Owner
Value
Investment #5
Description
Owner
Value
Investment #6
Description
Owner
Value
Investment #7
Description
Owner
Value
Investment #8
Description
Owner
Value
Investment #9
Description
Owner
Value
Investment #10
Description
Owner
Value
Other investments:
Retirement Benefits

Please use this section to list any retirement plans such as 401k, 403b, or IRAs

Retirement Benefit #1
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #2
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #3
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #4
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #5
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #6
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #7
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #8
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #9
Name
Owner
Primary Beneficiary
Value
Retirement Benefit #10
Name
Owner
Primary Beneficiary
Value
Other retirement benefits:
Please state whether you now receive Social Security Benefits and, if so, the basis for the benefits.
Please state if you are currently withdrawing funds from any of the above retirement accounts and, if so, the basis for the benefits.
Life Insurance:

Please use this section to list all life insurance contracts currently in force.

Insurance on Client's Life #1
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Client's Life #2
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Client's Life #3
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Client's Life #4
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Spouse's Life #1
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Spouse's Life #2
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Spouse's Life #3
Type of Coverage
Owner
Beneficiary
Face Value
Insurance on Spouse's Life #4
Type of Coverage
Owner
Beneficiary
Face Value
Other retirement benefits:
Personal Property
Please list any personal property of extraordinary value or property for which you plan to make specific designations upon your death.
Miscellaneous Assets
Use the space provided to provide information for miscellaneous assets or assets not yet identified in this questionnaire. Examples of such assets would be, literary rights, patent rights, etc.
Liabilities
Please indicate any liabilities, other than those disclosed previously in the real property section.


 
   
 
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* Information is for informational purposes only and not to be relied upon as legal adviceHeney and Associates, LLC is an approved Hyatt Metlife law firm