MAXWELL LAW FIRM,
PLLC
Estate Planning
Profile/Questionnaire
GENERAL
INFORMATION
Name ________________________________ Name (Spouse)______________________
Address_______________________________
Address____________________________
Telephone (h)___________(w)_____________
Telephone (h)___________(w)__________
Date of Birth___________Male___Female___ Date of Birth
________Male___Female___
Occupation____________________________
Occupation__________________________
Citizenship____State of Residence_________ Citizenship____State
of Residence_______
Social Security # _______________________ Social
Security #______________________
Pre-tax Household Income_______________ Pre-Tax
Household Income Needed to support Present Lifestyle_____________
Name of Accountant, if Any_______________ Accountant’s
Phone #__________________
Accountant’s Address____________________
____________________________________
Do you have a will now (Y/N)_____________
Have you created any trusts (Y/N)________
Date of Existing Will____________________
PERSONAL ASSESSMENT
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Children information |
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Name |
Date of Birth |
Address |
Add’l |
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Do you have any step-children
or other persons who you would like to be considered children for purpose of
your will ?_________________________________
Do you have a child, grandchild, parent or spouse with
a special need?______________
Do you have any special concerns due to the current or
prior marriage of any family member?
_____________________________________________________________________________
______________________________________________________________________________
GUARDIANS
OF CHILDREN
NAMES RELATIONSHIP ADDRESSES
______________________________________________________________________________
What are your primary estate planning concerns:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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ASSETS |
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Assets |
Value (statement if
available) |
Location |
Liens/Mortgages/Creditors |
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Checking & Savings |
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Money Mkt Funds |
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CDS |
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Stocks |
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Stock Options (Net After Tax) |
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Taxable Bonds |
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Tax-Exempt Bonds |
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Equity Mutual Funds |
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Fixed-Income Mutual Funds |
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Notes |
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Fixed Annuities |
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Variable Annuities |
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Limited Partnership |
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Personal Residence |
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REAL
ESTATE |
Deed (Attach) |
Address |
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Life Insurance: |
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Face Amt.2 |
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Business Interests3 |
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Collectibles/Other Personal Assets |
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IRAs |
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401(k), 403(b)s, Pension, Profit Sharing |
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Non-qualified Plans |
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Other (include cash value
of life ins. on another’s life) |
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Checking & Savings |
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Money Mkt Funds |
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CDS |
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Stocks |
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Stock Options (Net After Tax) |
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Taxable Bonds |
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Tax-Exempt Bonds |
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Equity Mutual Funds |
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Fixed-Income Mutual Funds |
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Notes |
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Fixed Annuities |
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Variable Annuities |
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Limited Partnership |
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Personal Residence |
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Real Estate1 |
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Life Insurance: |
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Face Amt.2 |
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Business Interests3 |
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Collectibles/Other Personal Assets |
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IRAs |
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401(k), 403(b)s, Pension, Profit Sharing |
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Non-qualified Plans |
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Other (include cash value
of life ins. on another’s life) |
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Notes |
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Fixed Annuities |
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Variable Annuities |
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LIFE INSURANCE *ATTACH A STATEMENT |
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Insurance Company |
Type
Policy |
Policy |
Amount |
Owner
of Policy |
Beneficiary |
Cash Value |
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EXECUTORS
Who are your choices for Executor and Substitute Executor:
NAMES RELATIONSHIP ADDRESSES
____________________________________________________________________________
TRUSTEES
Who are your choices for Trustees and Substitute
Trustees?
NAMES
RELATIONSHIP ADDRESSES
SUPPLEMENT 1
OWNED BUSINESS INTERESTS
1.
Describe the type of business you own or have an interest in (include the name
and address)
2.
Describe your ownership interest in the business
3.
If you die:
a.
Does your interest continue (Y/N) ________
b.
Is your interest insured by a buy-sell agreement or other agreement (Y/N) _____;
If
yes, describe generally the agreement.
4.
What is the estimated dollar value of your interest in the business
$______________
5. How did you value your interest?
PLEASE
ATTACH ANY