Estate Planning Information Sheet 5
by
Total Value of all Business Interests (net of liabilities or any mortgages associated with the business):
Owned by you: $________________________ Owned by your spouse: $________________________
Owned by You Jointly: $______________________
Other Information:
(1) Do you or your spouse expect any large inheritance? (Yes/No)__________________
If yes, please estimate the value of such inheritance:
Expected by You: $________________ From Whom:________________________________
Expected by Spouse: $________________ From Whom:_________________________________
(2) Have you or your spouse created a trust for another family member? (Yes/No)__________________
Are you or your spouse the beneficiary of a trust created by someone else? (Yes/No)_____________
(3) Will you have a need to create a trust to provide for the care of a parent or other extended family member should you predecease them? (Yes/No)____________
Will your spouse, if any, need to create such a trust for their parent or other extended family member, should that family member outlive your spouse? (Yes/No) ___________
(4) Have you made any large gifts to anyone other than your spouse (in excess of $3,000 before 1982, or greater than $10,000 after 1982)? (Yes/No) ________ If yes, please list the amount of such gifts and the year made. ___________________________________________________________________
________________________________________________________________________________
(5) Have you ever filed a gift tax return? . If so, please list the year or years for which such return was filed. . (if so filed, please provide copies)
(6) Do you and your spouse both have an existing Will? ______ If yes, when last updated? _________
Have an existing power of attorney? . If you do, is there a problem if the power of attorney is updated with a “tax-advantaged” gifting power or do either you or the person named in the power as your agent now have serious health problems? (Yes/No)__________________
(7) Do you anticipate any substantial changes in your or your spouse’s health or financial situation in the near future? (Yes/No) . If yes, please explain:
________________________________________________________________________
(8) Last time your comprehensive liability and/or commercial insurance programs were reviewed and updated? _________ Do you have an umbrella insurance policy to cover claims and liabilities in excess of your basic automobile and homeowner’s coverages? (Yes/No) _________
(9) Do you and your spouse, if applicable, and your respective parents if living, have long-term care policies in force? (Yes/No) ___________. If living, names and ages of your respective parents:
_______________________________________________________________________________
(10) Do you, your spouse if applicable, or your respective parents have any current health problems? (Yes/No)_________ If yes, please explain: ____________________________________________
_________________________________________________________________________________
(11) Do you currently have a Bank Safety Deposit Box? (Yes/No) __________ If yes, what is the number and where is it located? ____________________________________________________________
Is anyone else listed on that Deposit Box who would have immediate access in the event of your death or incapacity? __________ If yes, please provide their name, phone number and address:
________________________________________________________________________________
(12) Are there any other matters not addressed in this Information Checklist that you believe are relevant to your estate planning or family situation (again, all information shared with us will be maintained in strictest confidence)?
________________________________________________________________________________
