EP Questionnaire.MARRIED – FILLABLE (pdf)FILLABLE MARRIED EP Questionnaire
ESTATE-PLANNING QUESTIONNAIRE OF KING LEGAL GROUP, S.C.
If you wish to have a free analysis and price consultation for your estate-planning needs, please:
1. Download the fillable PDF version of this questionnaire.
or
2. Download the Microsoft® Word® version of this questionnaire.
or
3. Copy and paste the questionnaire found below into an email and forward it to us.
PDF VERSION FILLABLE |
WORD® DOCUMENT |
1. FAMILY BACKGROUND Date Prepared:
HUSBAND WIFE
Name: __________________ __________________
Date of Birth: __________________ __________________
Employment: __________________ __________________
Soc. Sec. No.: __________________ __________________
U.S. Citizen: Yes/No Yes/No
Prior Marriage: Yes/No Yes/No
Children by: Yes/No Yes/No
Prior Marriage: Yes/No Yes/No
Address: ____________________________________________________________________
Home Phone: ______________ Business Phone: ______________
Date of Marriage: ______________ Date of Wisconsin Residency: __________
Child of
CHILDREN AGE ANOTHER MARRIAGE MARRIED
1. Yes/No Yes/No
2. Yes/No Yes/No
3. Yes/No Yes/No
4. Yes/No Yes/No
On a separate sheet (to be attached to this questionnaire), please list the names of any additional children.
GRANDCHILDREN AGE RELATED PARENT MARRIED
1. ____ YES/NO
2. ____ YES/NO
3. ____ YES/NO
4. ____ YES/NO
Please list any additional grandchildren on a separate sheet to be attached to this questionnaire.
GREAT GRANDCHILDREN: YES/NO
ANY ISSUE SUFFER FROM DISABILITIES: YES/NO
2. FIDUCIARIES Please indicate who you would like to serve as the following:
(a) PERSONAL REPRESENTATIVES – This is the person who acts as the executor of your estate. Their duties and responsibilities entail making sure that your wishes and desires as listed in your will are carried out.
HUSBAND
Personal Representative:
Address:
Alternate #1:
Address:
Alternate #2 (optional):
Address:
WIFE:
Personal Representative:
Address:
Alternate #1:
Address:
Alternate #2 (optional):
Address:
(b) TRUSTEE – If your estate plan will include a trust, this person’s or entity’s duties and responsibilities will be to ensure that the terms of the trust document are carried out.
Name:
Address:
Alternate #1:
Address:
Alternate #2 (optional):
Address:
Corp. Trustee:
Address:
(c) TRUST DISTRIBUTIONS:
Outright at Certain Age:
Specific Time Line:
(for example, 1/3 at age 21, 1/3 at age 28, 1/3 at age 30):
(d) GUARDIANS FOR MINOR CHILDREN:
Name:
Address:
Alternate #1:
Address:
Alternate #2 (Optional):
Address:
(e) DURABLE POWER OF ATTORNEY – This is the person you are appointing with the power to make your financial decisions in the event that you are unable to do so.
HUSBAND
Name:
Address:
Soc. Sec. No.:
Co-attorney (Optional):
Address:
Soc. Sec. No.:
WIFE
Name:
Address:
Soc. Sec. No.:
Co-attorney (Optional):
Address:
Soc. Sec. No.:
(f) HEALTH CARE POWER OF ATTORNEY – This is the person you are appointing with the power to make your healthcare decisions in the event that you are unable to do so.
HUSBAND
Name:
Address:
Phone No.:
Alternate #1
Address:
Phone No.:
Alternate #2 (Optional)
Address:
Phone No.:
WIFE
Name
Address
Phone No.
Alternate #1
Address
Phone No.
Alternate #2 (Optional)
Address
Phone No.
This document will also address the following situations that you will need to address in the document. If you are unsure as to how you would answer this question or need to discuss this further, please leave this blank.
If you are terminally ill or in a comatose-like state (that is, a vegetative state) and are not expected to recover as confirmed by at least two physicians, is it your desire to have your life prolonged with life support systems and feeding tubes?
Husband _____________ (yes or no) Wife ________________ (yes or no)
3. ESTATE-PLANNING INFORMATION
Wills YES/NO Bring copies
Trusts YES/NO Bring copies
Marital Agreement YES/NO Bring copies
Power of Attorney YES/NO Bring copies
Living Wills YES/NO Bring copies
Gift-Tax Returns YES/NO Bring copies
Power of Apt.
under any
trust or other
instrument Husband YES/NO Wife YES/NO
Expected
inheritance Husband YES/NO $ Wife YES/NO $
4. ASSETS (Indicate if any assets are jointly owned with another person.)
HUSBAND’S WIFE’S JOINTLY
SOLE NAME R* SOLE NAME R* OWNED R*
(a) Investments (R*= Interest Rate)
1. Cash or equivalent
(for example, savings, CD)
2. Stocks and Bonds
(b) Real Estate
(Indicate if out of state.)
1. Residence _________ __________ ________
Mortgage ( ) ( ) ( )
2. Vacation Home _________ __________ ________
Mortgage ( ) ( ) ( )
3. Investment _________ __________ ________
Property Mortgage ( ) ( ) ( )
(c) Business Interest
1.
2.
3.
HUSBAND’S WIFE’S JOINTLY
SOLE NAME R* SOLE NAME R* OWNED R*
(d) Personal Property
1. Auto/Boat
2. Home furnishing
3. Other (Identify)
a.
b.
(e) Other Assets
1.
2.
3.
4.
(f) Employee Benefits
1.
2.
3.
4.
(g) Life Insurance (Non-Business)
Face Policy
Company: Policy No. Value Loans Owner Insured Beneficiary
1.
2.
3.
H. Husband’s Trust Interest
Wife’s Trust Interest
5. DEBTS OTHER THAN LOANS AND MORTGAGES LISTED ABOVE
HUSBAND’S WIFE’S JOINTLY
SOLE NAME SOLE NAME OWNED
(a)
(b)
(c)
(d)
(e)
6. INCOME
HUSBAND WIFE
Salary/Wages
Other
Description of other income:
7. PRIOR TAXABLE GIFTS (that is, gifts of more than $13,000 annual amount per individual or $26,000 annual amount for married couples)
Date Donor Recipient Amount
8. MISCELLANEOUS
Safe Deposit box YES/NO Location
Accountant YES/NO Name & Phone No. Broker YES/NO Name & Phone No.
Life Insurance Agent YES/NO Name & Phone No. Banking relationship YES/NO Name
OTHER UNIQUE FACTS OR CIRCUMSTANCES TO BE CONSIDERED: