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Estate Planning Worksheet - Married Individuals

Using this form will assist us in designing an estate plan that meets your goals. All information provided is strictly confidential.
Click “submit” when finished. (This form does NOT allow you to partially complete it and return to the form to enter additional information.)

Part I

Personal Information

Client's Full Legal Name

First Last

Also Known As

First Last

Preferred To Be Called

Full Name

Birth Date

Month

Day

Year

Social Security #

US Citizen?

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Telephone

Mobile Telephone

County of Residence

It is okay to communicate with me via my E-mail Address.

Yes

Client’s Spouse or Second Grantor’s Legal Name

Name most often used to title property & accounts

First Last

Also Known As

First Last

Prefer To Be Called

Birth Date

MM slash DD slash YYYY

Social Security #

US Citizen?

Employer Information

Employer

Position

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Marital Status

Divorced

Married

Single

Widowed

Children and Other Family Members

1. Name (Full Legal Name)

Birth Date

MM slash DD slash YYYY

Relationship

Address/Phone Number/Email

2. Name

Birth Date

MM slash DD slash YYYY

Relationship

Address/Phone Number/Email

3. Name

Birth Date

MM slash DD slash YYYY

Relationship

Address/Phone Number/Email

4. Name

Birth Date

MM slash DD slash YYYY

Relationship

Address/Phone Number/Email

5. Name

Birth Date

MM slash DD slash YYYY

Relationship

Address/Phone Number/Email

Advisors

Personal Attorney

Phone

Accountant

Phone

Financial Advisor

Phone

Life Insurance Agent

Phone

Your Concerns

Please rate the following as to how important they are to you: (H high concern, S some concerned, L low concern, N/A no concern or not applicable)

Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.

H (High Concern)

S (Some Concern)

L (Low Concern)