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NAME ______________________________ SPOUSE __________________________
ADDRESS _____________________________________________________________________
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HOME PHONE _______________WORK PHONE ______________ FAX __________
E-MAIL ADDRESS _______________________________
OCCUPATION _______________________ SPOUSE __________________________
CHILDREN __________________________ ___________________________________
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OTHERS TO BE CONSIDERED IN ESTATE PLAN
NAME AND RELATIONSHIP
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CASH AMOUNT ________________
BANK - ACCOUNT NO. - AMOUNT
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SECURITIES ____________________________________________________________
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PROMISSORY NOTES ____________________________________________________
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REAL ESTATE ____________________________________________________________
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PARTNERSHIP INTERESTS ________________________________________________
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BUSINESS INTERESTS ___________________________________________________
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INDIVIDUAL RETIREMENT ACCOUNTS ____________________________________
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PENSION & PROFIT SHARING PLANS ______________________________________
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LIFE INSURANCE ________________________________________________________
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OTHER ASSETS __________________________________________________________
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MAJOR LIABILITIES ____________________________________________________
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LAWSUITS -- PENDING AND POTENTIAL __________________________________
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JUDGMENTS -- PENDING AND POTENTIAL ________________________________
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NET WORTH _____________________________________________________________
ESTATE PLANNING GOALS
_____ Avoidance of Probate _____ Reduction of Estate Tax _____ Asset Protection
_____ Guardian for Children _____ Preservation of Estate
_____ Maintenance of Privacy _____ Reduction of Income Tax
QUESTIONS, COMMENTS, OTHER INFORMATION I SHOULD HAVE.
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