Step 1 of 7 14% CLIENT PERSONAL INFORMATIONName(Required) First Last Date of Birth(Required) Month Day Year Citizenship(Required) US citizen Naturalized citizen Resident alien Occupation(Required) Employment Status(Required) Retired Employed Marital Status(Required) Single/Widow(er) Married Date of Marriage Month Day Year Marriage First Second Other SPOUSE'S PERSONAL INFORMATION (if applicable)Spouse's Name First Last Date of Birth Month Day Year Date of Death (if applicable) Month Day Year Citizenship US citizen Naturalized citizen Resident alien Occupation Employment Status Retired Employed Marriage First Second Other CONTACT INFORMATIONYour Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home #Cell #Cell 2 #Work #Email Address(Required) Email Address 2 Which number(s) would you prefer to be contacted at?(Required) Home Cell Work Select all that applyWhat is the best time?(Required) Referred to us by (Name) Referred to us by (Firm Name) CONTACTSFinancial Advisor Name First Last Financial Advisor Firm Financial Advisor PhoneAccountant Name First Last Accountant Firm Accountant Phone Are you or your spouse a veteran?(Required) Yes No If yes, is it you or your spouse(Required) You Spouse Dates of Service(Required) EXISTING ESTATE PLANNINGDo You Have a Will?(Required) Yes No Does Your Spouse Have a Will? Yes No Date Will Executed Do You Have a Trust?(Required) Yes No Does Your Spouse Have a Trust? Yes No Date Trust Executed Do You Have a Power of Attorney?(Required) Yes No Does Your Spouse Have a Power of Attorney? Yes No Date POA Executed Do You Have a Health Care Proxy?(Required) Yes No Does Your Spouse Have a Health Care Proxy? Yes No Date Health Care Proxy Executed Do You Have a Living Will?(Required) Yes No Does Your Spouse Have a Living Will? Yes No Date Living Will Executed Do You Have Long-Term Care Insurance?(Required) Yes No Does Your Spouse Have Long-Term Care Insurance? Yes No Daily Benefit Length of Benefit Have you transferred or gifted away assets away in the last 60 months?(Required) Yes No AmountDate HEALTH STATUSYour health status plays an important role in the designing of an estate plan best suited for you and your loved ones. Your Current Health Status(Required) Good Concern Problem Your specific concern/problemYour Spouse's Current Health Status Good Concern Problem Spouse's specific concern/problemWhat would completing your estate planning accomplish for you?What do you see as your biggest risk if you don’t complete your estate plan?PERSONAL/FAMILY INFORMATIONDo you have children?(Required) Yes No If yes, how many?Please specify: Joint Mine Step Adopted Foster Do you have grandchildren?(Required) Yes No If yes, how many?Does your spouse have children? Yes No If yes, how many?Please specify: Joint Mine Step Adopted Foster Does your spouse have grandchildren? Yes No If yes, how many?CHILDREN and GRANDCHILDRENChildren/Grandchildren InformationClick the button to add information about your children and grandchildren. Name Gender Date of Birth Actions Edit Delete There are no Children/Grandchildren. Add Child/Grandchild Maximum number of children/grandchildren reached. ANY OTHER PERSON OR ENTITY NAMED IN YOUR PLANSiblings, entities like churches, charities, executors, trustees or any other named personOther people or entities named in your planClick the button to add information about any other people or entities named in your plan. Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. YOUR MONTHLY INCOMEWagesPensionSocial SecurityInvestmentsOtherYour Total IncomeCalculated fieldYOUR SPOUSE'S MONTHLY INCOMEWagesPensionSocial SecurityInvestmentsOtherSpouse's Total IncomeCalculated fieldJOINT MONTHLY INCOMEWagesPensionSocial SecurityInvestmentsOtherTotal Joint IncomeCalculated fieldTOTAL MONTHLY INCOMECalculated fieldsTotal WagesTotal PensionTotal Social SecurityTotal InvestmentsTotal Other IncomeTotal Income YOUR ASSET INFORMATIONAsset information as of (date) Cash, Checking, Savings, CDs, Money Market & Cash Management AccountsInvestment/Broker-held Accounts (not including cash) and Mutual Fund AccountsRetirement Accounts: IRA, 401K, 403B, SEP, etc.Life Insurance: death benefitLife Insurance: cash valueStocks you hold outside of brokerage accountsBonds you hold outside of brokerage accountsAnnuities: original amount investedAnnuities: month/year purchased Annuities: current valueReal estate: residence (per tax bill)Real estate: otherVehicles: automobile, motorcycle, boats, snowmobiles, etc.Your Total AssetsCalculated fieldYOUR SPOUSE'S ASSET INFORMATIONCash, Checking, Savings, CDs, Money Market & Cash Management AccountsInvestment/Broker-held Accounts (not including cash) and Mutual Fund AccountsRetirement Accounts: IRA, 401K, 403B, SEP, etc.Life Insurance: death benefitLife Insurance: cash valueStocks spouse holds outside of brokerage accountsBonds spouse holds outside of brokerage accountsAnnuities: original amount investedAnnuities: month/year purchased Annuities: current valueReal estate: residence (per tax bill)Real estate: otherVehicles: automobile, motorcycle, boats, snowmobiles, etc.Spouse's Total AssetsCalculated fieldJOINT ASSET INFORMATIONCash, Checking, Savings, CDs, Money Market & Cash Management AccountsInvestment/Broker-held Accounts (not including cash) and Mutual Fund AccountsRetirement Accounts: IRA, 401K, 403B, SEP, etc.Life Insurance: death benefitLife Insurance: cash valueStocks you jointly hold outside of brokerage accountsBonds you jointly hold outside of brokerage accountsAnnuities: original amount investedAnnuities: month/year purchased Annuities: current valueReal estate: residence (per tax bill)Real estate: otherVehicles: automobile, motorcycle, boats, snowmobiles, etc.Total Joint AssetsCalculated fieldTOTAL ASSETSCalculated fieldsTotal Cash, Checking, Savings, CDs, Money Market & Cash Management AccountsTotal Investment/Broker-held Accounts (not including cash) and Mutual Fund AccountsTotal Retirement Accounts: IRA, 401K, 403B, SEP, etc.Total Life Insurance: death benefitTotal Life Insurance: cash valueTotal stocks held outside of brokerage accountsTotal bonds held outside of brokerage accountsTotal annuities: original amount investedTotal annuities: current valueTotal real estate: residence (per tax bill)Total real estate: otherTotal vehicles: automobile, motorcycle, boats, snowmobiles, etc.Total AssetsOTHER ASSETS NOT LISTEDOther AssetsTypeOwner(s)Value($) Add RemoveClick the plus button to add additional lines.Total Other AssetsEnter the total amount of other assets YOUR LIABILITIESMortgageLoans PayableOtherYour Total LiabilitiesCalculated fieldYOUR SPOUSE'S LIABILITIESMortgageLoans PayableOtherYour Spouse's Total LiabilitiesCalculated fieldJOINT LIABILITIESMortgageLoans PayableOtherTotal Joint LiabilitiesCalculated fieldTOTAL LIABILITIESCalculated fieldsTotal MortgageTotal Loans PayableTotal OtherTotal Liabilities YOUR BUSINESS INTERESTSFarmPartnership or LLC InterestCorporationOtherYour Total Business InterestsCalculated fieldYOUR SPOUSE'S BUSINESS INTERESTSFarmPartnership or LLC InterestCorporationOtherYour Spouse's Total Business InterestsCalculated fieldJOINT BUSINESS INTERESTSFarmPartnership or LLC InterestCorporationOtherTotal Joint Business InterestsCalculated fieldTOTAL BUSINESS INTERESTSCalculated fieldsTotal FarmTotal Partnership or LLC InterestTotal CorporationTotal OtherTotal Business InterestsHow much are your total monthly living expenses?Notes/Comments:PhoneThis field is for validation purposes and should be left unchanged.
