Client #2

Full Legal Name

Soc.Sec.No. (Last 4 Digits)

Name you want on your documents

Nickname

Date of Birth

Religion

Current or prior employment

Retired?
YesNo

Are you a US citizen?
YesNo

If no the what country?

Your family advisory may be your financial planner, CPA, insurance agent, other attorneys, bankers or stock broker. We are interested in those that you rely on and have confidence in regarding your finances.

CPA Name

Email

Firm Name

Telephone No.

Financial Advisor

Email

Firm Name

Telephone No.

Other Advisor

Email

Firm Name

Telephone No.

Are any of these advisors what you consider to be your “trusted advisor”? is this some one you would

want included in the planningcall to tell them about your planning when donewant copies of planning sent

If so who?

1. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

2. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

3. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

4. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

IMPORTANT Are any of the above some one you would

want to include in planningwant copies of planning sentcall to tell them about your planning when donewant to meet us

If so who?

5. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

6. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

7. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

8. Name

Nickname

Sex:
MaleFemale

Date of Birth

Relationship to You

Address

Phone

Email

Relationship Status:
MarriedPartnerDivorcedWidowedSingle

Spouse/Partner Name

Children & Ages

Concerns

IMPORTANT Are any of the above some one you would

want to include in planningwant copies of planning sentcall to tell them about your planning when donewant to meet us

If so who?

1.Name

Relationship

Address

Telephone

Email

Comments

2.Name

Relationship

Address

Telephone

Email

Comments

3.Name

Relationship

Address

Telephone

Email

Comments

4.Name

Relationship

Address

Telephone

Email

Comments

5.Name

Relationship

Address

Telephone

Email

Comments

Funeral and Burial Information

Preferred Funeral Home

PrearrangementsPrepaid

Do you have funeral lots?
YesNo

If so, where?

Do you prefer to be cremated?
YesNo

If so, ashes disposed of

Are you a veteran?
YesNo

If so, do you want a military funeral with honors?
YesNo

Comments

Client #1Client #2

Have you been previously divorced?

Client #1Client #2

If so are you making payments to a divorce decree? (please bring copy)

Client #1Client #2

If you are currently married, have you ever lived in any of the following states while married to your current spouse? AZ, CA, ID, LA, NV, NM, TX, WA, WI

Client #1Client #2

Have you filed federal or state gift tax returns? (please bring a copy)

Client #1Client #2

Do you have prior wills, trusts, or other estate planning documents? (please bring a copy)

Client #1Client #2

Are you expecting an inheritance from anyone?

Client #1Client #2

Do you have long term care insurance?

Client #1Client #2

Do you have any major health concerns?

Client #1Client #2

Do you have any creditor problems or concerns?

Client #1Client #2

Do any of your children or grandchildren have special education, medical, or physical needs? If so who?

Client #1Client #2

Do you have any other special concerns about any of your children or grandchildren?

Client #1Client #2

Do you financially assist any adult child, sibling, or parent?

Client #1Client #2

Do you need to plan for children from a previous marriage or relationship?

Client #1Client #2

Are you concerned about protecting a child’s inheritance from creditors or divorced spouses?

Client #1Client #2

Do you have special concerns about your current income or assets you own?

Client #1Client #2

Do you need to find a new CPA, Financial Advisor, or other professional to assist you?

Client #1Client #2

Do you maintain a safe deposit box?

Client #1Client #2

Do you store information, files, photographs, or other digital media assets that are valuable to you? Where?

Client #1Client #2

Are you concerned about probate, the probate process, and minimizing probate?

Client #1Client #2

Are there any questions we are not asking about?

Please list any of the following

Bank Accounts (checking, savings, C.D's)Brokerage Accounts (identify IRA's or other retirement accounts)AnnuitiesRetirement AccountsSavings BondsBusiness Entities (and value guess)Stock and BondsReal EstateLife InsuranceOther Valuable Assets (mortgages, partnerships, etc.)Liabilities (mortgages, credit lines, other significant debt)Pension and Social Security

1.Description of Asset

Owner (how is the account titled?)

Estimated Value

2.Description of Asset

Owner (how is the account titled?)

Estimated Value

3.Description of Asset

Owner (how is the account titled?)

Estimated Value

4.Description of Asset

Owner (how is the account titled?)

Estimated Value

5.Description of Asset

Owner (how is the account titled?)

Estimated Value

6.Description of Asset

Owner (how is the account titled?)

Estimated Value

7.Description of Asset

Owner (how is the account titled?)

Estimated Value

8.Description of Asset

Owner (how is the account titled?)

Estimated Value

9.Description of Asset

Owner (how is the account titled?)

Estimated Value