Confidential Personal Information Form


    Client #1

    Retired?
    YesNo

    Are you a US citizen?

    Status:

    If married Do you have a pre- post-marriage agreement?

    Client #2

    Retired?
    YesNo

    Are you a US citizen?

    Family Advisors

    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.





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

    If so who?

    Children (including deceased children)
    And other people you name as beneficiaries


    Sex:

    Relationship Status:


    Sex:

    Relationship Status:


    Sex:

    Relationship Status:


    Sex:

    Relationship Status:


    IMPORTANT Are any of the above some one you would

    Children (including deceased children)
    And other people you name as beneficiaries

    Sex:

    Relationship Status:


    Sex:

    Relationship Status:


    Sex:

    Relationship Status:


    Sex:

    Relationship Status:

    IMPORTANT Are any of the above some one you would

    Other People or Charities/Schools/Churches You Plan to Name in Your Planning
    (to receive money or to be named as an executor, trustee, or other position of authority)





    Funeral and Burial Information

    Do you have funeral lots?

    Do you prefer to be cremated?

    Are you a veteran?

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

    Important Family Question
    Please check a box if it applies to you.

    Have you been previously divorced?


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


    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


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


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


    Are you expecting an inheritance from anyone?


    Do you have long term care insurance?


    Do you have any major health concerns?


    Do you have any creditor problems or concerns?




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


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


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




    Do you maintain a safe deposit box?



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


    Asset Overview

    Please list any of the following