Please check each box below that describes the purpose for your visit.*

To have my/our existing estate plan reviewed

To reduce/eliminate taxes

To protect my/our assets from lawsuits and future judgments creditors

To learn about estate planning

To reduce/eliminate capital gains taxes

To protect my/our children’s inheritance from divorce and creditors

To have a will prepared

To protect my/our IRAs or other retirement plans from excessive taxes

To protect my/our grandchildren’s inheritance from divorce and creditors

To have a trust prepared

To reduce/eliminate the cost of probate

To start a gift program for children, grandchildren, or others

Your Name

First Last

U.S. Citizen?*

Yes

Your Social Security Number*

Your Date of Birth*

Month

Day

Year

Your health?*

Good

Fair

Poor

Your Email*

Your Phone Number*

Current Occupation: If retired, from what?*

Married?*

Yes

Spouse's Name

First Last

Spouse U.S. Citizen?*

Yes

Spouse's Social Security Number*

Spouse's Date of Birth

Month

Day

Year

Spouse's Health?*

Good

Fair

Poor

Spouse's Email

Spouse's Phone Number

Spouse's Current Occupation? If retired, from what?

Date of Marriage

Month

Day

Year

Address*

Street Address Address Line 2 City State ZIP Code

Your Children, if any, or other potential beneficiaries

List

Legal Name

Child's Parent (Husband,Wife,Both)

Date of Birth

Age

M / F

If married, spouse name

If child has children, how many

Who referred you to us?

Referrer Name

Referrer Firm

Referrer Phone Number

Your Advisors, In case we need to consult with them.

Certified Public Accountant

CPA Name

CPA Firm

CPA Phone

Financial Consultant

Consultant Name

Consultant Firm

Consultant Phone Number

Life Insurance Professional

Professional's Name

Professional's Firm

Professional's Phone Number

Attorney

Attorney Name

Attorney Firm

Attorney Phone Number

Your Assets

Please provide us with an estimate of the value of your assets, or estate, by completing the following schedule. For life insurance policies, please provide the death benefit or the face value, whichever is greater (NOT THE CASH VALUE). For all other assets use your best estimate of each assets fair market value, disregarding what you paid for the asset or what it was worth when you inherited it.

Example assets we'd like you to include:

Personal Residence
Other Real Estate
IRA’s, 401(K)s, & Other Retirement Plan Accounts
Annuities
Life Insurance Policies
Business Interests (Sole Proprietorships, C- Corps, S-Corps, LLC’s & Partnerships)
Brokerage Accounts

Stocks (Individually Held)
Bonds (Individually Held)
Cash Accounts (Checking, Savings & CD’s)
Money Owed to You (Notes Receivable)
Vehicles
Household Goods & Other Personal Property
Other Assets or Debts

Assets List

Asset Type

Value in your name

Value in spouse's name

Value in joint name

Amount of debt on asset

Press the "+" on the right to add another row.

Total Net Estate Value

(Total Value - Total Debt on Assets) = Total Net Estate Value

Estate Planning Questionnare

Your Children, if any, or other potential beneficiaries

Who referred you to us?

Your Advisors, In case we need to consult with them.

Certified Public Accountant

Financial Consultant

Life Insurance Professional

Attorney

Your Assets

Example assets we'd like you to include:

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