Ulti Clocks content

Earthblog

A Real-World Joomla! Template

 
Wills and Trusts Intake Form
PERSONAL DATA
Your name:
Spouse's name:
Your address:
Your home phone number:
Your cell phone number:
Your work phone number:
Your e-mail address:
Spouse's cell phone number:
Spouse's e-mail address::
Your date of birth:
Spouse's date of birth:
Your Social Security number:
Spouse's Social Security number:
Your occupation:
Your employer:
Spouse's occupation:
Spouse's employer:
Your citizenship:
Spouse's citizenship:
Your mother:
Your father:
Spouse's mother:
Spouse's father:
If you or your spouse have been previously married, please tell us whether the marriage ended in death or divorce. If there was a divorce, please bring a copy of the Divorce Judgment with you when you come in for your interview
Previous Marriages:
Names:
Addresses:
Ages:
Social Security numbers of children of this marriage (including deceased children):
Names, addresses, ages, and Social Security numbers of Husband’s children not listed above (including deceased children)
Husband's Children:
Names, addresses, ages, and Social Security numbers of Husband’s children not listed above (including deceased children)
Wife's Children:
Do any of the previously mentioned family members suffer from a legal, physical, or mental disability?
Legal, Physical, or Mental Disability:
yes
no
If yes, please describe:
Name of your choice for a Guardian to care for minor children:
1st Choice:
Relation:
Address:
2nd Choice:
Relation:
Address:
Name of your choice for an Executor to probate your Will
1st Choice:
Relation:
Address:
2nd Choice:
Relation:
Address:
Are there any specific items or sums of money that you would like to give to a particular person or charity?
Charitable Gifts:
yes
no
If yes, please list:
To your spouse, if surviving?:
yes
no
To your children, if spouse is not surviving, and at what age(s) (e.g., half at age 25, balance at age 30)
Describe:
To children of previous marriage?:
yes
no
If yes, what portion?:
If spouse and children are deceased, to whom?:
Would you and/or your spouse like your Last Will to specify cremation?:
yes
no
Please describe any other special burial/funeral arrangements:
BANK ACCOUNTS (Savings, checking, money market accounts, C.D.’s, etc.)
Please give bank or credit union name, approximate balance, type of account, and name(s) on account.
a):
b):
c):
RETIREMENT ACCOUNTS (IRA’s, 401k’s, pension, etc.)
Please give financial institution name, approximate balance, type of account, and name(s) on account.
a):
b):
c):
STOCKS, BONDS, MUTUAL FUNDS
Please state number of shares, company name, type of security, name(s) on certificate, value, and basis:
a):
b):
c):
REAL ESTATE
1. Your residence:
a) Do you own your own home?:
yes
no
b) Approximate market value:
c) Mortgage or land contract balance:
d) Name(s) on title(s):
2. Other property:
a) Do you own other real estate?:
yes
no
b) Address:
c) Approximate Market value:
d) Mortgage or land contract balance:
e) Name(s) on title(s):
LIFE INSURANCE
1. Regarding yourself, please state company name, policy number, amount, and beneficiary:
a):
b):
c):
2. Regarding your spouse, please state company name, policy number, amount, and beneficiary:
a):
b):
c):
3. Do we have permission to contact employers, insurance agents, etc., regarding change of beneficiaries(ies)
Please answer yes/no:
yes
no
DEBTS/LIABILITIES
Do you have any significant debts or liabilities? Are you currently a defendant in a lawsuit? Are you aware of any circumstance that could result in a lawsuit against you?
Please Provide Details:
MISCELLANEOUS
1. Your automobile:
Owned/Leased:
Owned
Leased
Year:
Make:
Model:
Value:
Loan Balance:
2. Spouse’s automobile:
Owned/Leased:
Owned
Leased
Year:
Make:
Model:
Value:
Loan Balance:
3. Do you or your spouse own any of the following?
a) Business interest:
yes
no
b) Boat:
yes
no
c) Land contract payable to you:
yes
no
d) Coin collection:
yes
no
Other:
yes
no
If yes, please describe below:
4. Do you or your spouse expect any sizable inheritance?:
yes
no
If yes, please give details below:
5. Are you or your spouse beneficiaries under any trust?:
yes
no
If yes, please give details below:
6. Do you or your spouse have any legal powers of appointment over property owned by another?:
yes
no
If yes, please give details below:
7. Do you have a safe deposit box?:
yes
no
If so, where?:
8. Who is your stockbroker/financial planner? Provide name, address, telephone number:
9. Who is your accountant? Provide name, address, telephone number:
10. Who is your life insurance agent? Provide name, address, telephone number: