CONFIDENTIAL
PERSONAL AND FINANCIAL INFORMATION OF:
Name(s):
Date:
Attorney:
PERSONAL INFORMATION
CLIENT 1
Name:
Other Names Used:
Date and Place of Birth:
Primary Address:
Secondary Address:
Telephone Numbers:
Home:
Office:
Mobile:
Email:
Occupation, Title & Employer (or prior employment if retired):
Business Address:
No. of Years:
Citizenship:
Prior Marriages: [ ] Yes [ ] No
If Yes, list reason for termination of marriage (death, divorce, e.g.), name of prior spouse, and date of divorce if applicable:
Children of Prior Marriages: [ ] Yes [ ] No
If Yes, please list names and ages:
Year State Residence Established:
CLIENT 2
Name:
Other Names Used:
Date and Place of Birth:
Primary Address:
Secondary Address:
Telephone Numbers:
Home:
Office:
Mobile:
Email:
Occupation, Title & Employer (or prior employment if retired):
Business Address:
No. of Years:
Citizenship:
Prior Marriages: [ ] Yes [ ] No
If Yes, list reason for termination of marriage (death, divorce, e.g.), name of prior spouse, and date of divorce if applicable:
Children of Prior Marriages: [ ] Yes [ ] No
If Yes, please list names and ages:
Year State Residence Established:
FAMILY INFORMATION
CHILD 1
Name:
Address:
Telephone Number:
Date of Birth:
Child’s Occupation, Employer, Approximate Income and Approximate Net Worth:
Name and Date of Birth of Child’s Spouse, if any:
Names and Dates of Birth of Child’s Children, if any:
CHILD 2
Name:
Address:
Telephone Number:
Date of Birth:
Child’s Occupation, Employer, Approximate Income and Approximate Net Worth:
Name and Date of Birth of Child’s Spouse, if any:
Names and Dates of Birth of Child’s Children, if any:
CHILD 3
Name:
Address:
Telephone Number:
Date of Birth:
Child’s Occupation, Employer, Approximate Income and Approximate Net Worth:
Name and Date of Birth of Child’s Spouse, if any:
Names and Dates of Birth of Child’s Children, if any:
CHILD 4
Name:
Address:
Telephone Number:
Date of Birth:
Child’s Occupation, Employer, Approximate Income and Approximate Net Worth:
Name and Date of Birth of Child’s Spouse, if any:
Names and Dates of Birth of Child’s Children, if any:
Additional Personal, Family, Charitable and Planning Information:
1. Please describe briefly any health problems or special needs of family members:
2. Do you have any other dependents? If so, please explain:
3. Are any of your children or grandchildren adopted? If so, who:
4. Other Possible Beneficiaries:
5. Date and Place of Your Marriage:
6. Do you have a prenuptial or postnuptial agreement? [ ] Yes [ ] No
If yes, please attach a copy.
7. Safe Deposit Box Number: _____ Location: _____
In Whose Names?
8. Have you verified the status of your Social Security Account recently? [ ] Yes [ ] No
9. Do you anticipate receiving gifts or inheritances? [ ] Client 1 [ ] Client 2
If Yes, estimate amount and describe source:
10. Are you a beneficiary under a trust? [ ] Client 1 [ ] Client 2
If Yes, please identify the trust(s) and approximate market value:
11. Do you presently have a Will, Trust, Health Care Proxy or Durable Power of Attorney?
[ ] Client 1 [ ] Client 2
If Yes, please attach photocopies.
12. Have you at any time made gifts of cash or property which were reported on a Federal or State Gift Tax Return filed by you?
[ ] Client 1 [ ] Client 2
If Yes, please identify the amount(s) and year(s) of such gifts and attach photocopy of all gift tax returns:
13. Charitable Giving
Have you made any charitable gifts? [ ] Yes [ ] No
If yes, please identify the charities you have given to in the past and all existing pledges:
Do you wish to designate a charity(ies) as a beneficiary under your estate plan or retirement planning assets? [ ] Yes [ ] No
If yes, please identify which charity(ies) you would like to provide for:
Would you like to discuss more sophisticated charitable planning techniques at this time? [ ]Yes [ ] No
PROPOSED FIDUCIARIES AND AGENTS
Guardians
If you have any children who are less than 18 years old, your will should nominate one or more guardians. A guardian would be expected to have physical custody of your minor children and generally to watch out for their well-being. Typically your spouse would be named first, but it is desirable to name one or more successor guardians. If you use a trust as part of your estate plan, the guardian need not be someone who is sophisticated about financial affairs; the trustee can take care of these matters. State the name, residence and relationship, if any, of your choices:
Personal Representatives
One or more Personal Representatives must also be nominated in your will. Often a spouse is named as first choice for this position, but one or more successors should also be nominated. The Personal Representative is responsible for determining the nature and extent of the decedent’s assets, paying debts, investing estate assets, filing estate tax returns, filing accounts with the Probate Court, and distributing the remaining assets in accordance with the terms of the decedent’s will. The Personal Representative may retain a lawyer to handle the technical aspects of administering the estate. The Personal Representative’s job is generally completed within two to three years after death. State the name, residence, and relationship, if any, of your choices:
Trusts and Trustees
Uses of Trusts
Trusts can be useful vehicles to save estate taxes and to provide for the management of assets. Even though assets may be held in trust, they can continue to be available, subject to guidelines set out in the trust instrument, to provide for the financial well-being of a surviving spouse and other family members.
Tax Planning
Two of the main uses of trusts occur on the death of the first spouse. At that time, trusts can be established to ensure federal and state estate tax exemption amounts are fully utilized and to ensure optimal use of federal and state estate tax marital deductions (deductions allowed for property passing to a surviving spouse). These important concepts will be discussed with you during your estate planning conference.
Trusts for Children or Grandchildren
After the deaths of both spouses, it is often desirable to use trusts to hold assets for the benefit of children or other family members. For example, if your youngest child is 10 years old when both parents die, it would not be wise to provide for an outright distribution to him or her; the child’s share of the family assets can be held in trust.
After both spouses are deceased, a common plan is to retain assets in one trust for the benefit of all children until the youngest child reaches a specified age, such as 25. Such a trust is known as a “Common Pot” trust. One feature of the Common Pot trust is that it permits unequal distributions to be made among children based on need and the amount of financial resources available. For example, unequal amounts might be paid to subsidize the education of each of your children. Even though assets are held in a common trust, amounts may be distributed to any child to provide for health, support, education, or for other worthwhile purposes. The age of 25 is often chosen to provide children with an opportunity to complete college and, possibly, graduate school. A variation of this plan would be to distribute half the trust fund when the youngest child reaches age 25, and the balance when the youngest reaches age 30.
“Share Trusts” are often used as a supplement to, or instead of, the Common Pot plan. For example, when the youngest child reaches age 25 you might wish to divide the remaining trust assets into shares, one for each child. Each share could then be held as a separate trust and distributed independently of the other shares based on that child’s age. For example, after the youngest child reaches age 25 and separate shares are established, distributions from each child’s share trust could be made to him or her one third at age 30, one half the balance at age 35, and the balance at age 40, independent of the ages of his or her siblings.
In a smaller estate the common pot trust generally makes the most sense. In a larger estate, either plan, or a combination, could be used.
You might wish to retain property in trust for one or more children or grandchildren, but not for others. Do you have any children or grandchildren who should not receive a substantial outright distribution of assets after the deaths of both parents? If yes, please explain.
Trustees
The Trustee’s job is to invest trust assets and to distribute trust income and principal based on the terms of the trust instrument. The Trustee’s job may involve a long term commitment. Please list the name, residence, and relationship, if any, of your choices:
Failure of Descendants (“Disaster Clause”)
If your immediate family were all deceased, to whom would you like your assets to pass? For example, you might wish to have one half of your assets pass to the closest living relatives of Client 1 and one half to pass to the closest living relatives of Client 2, or you might wish to provide for a gift to charity(ies). Please state your wishes:
Durable Power of Attorney
A power of attorney is a document in which you name another person to act as your agent to do things on your behalf in financial matters and transactions. Generally, it becomes effective immediately when signed. A durable power remains effective even when you become incapacitated, for example, by a stroke. The person or persons (more than one agent may serve at the same time) you choose to represent you does not need to be an attorney at law, you may name your spouse, a relative or friend. It can be revoked or revised at any time.
Do you wish to have a durable power of attorney? _____
If so, please list the name, residence, and relationship, if any, of your choices:
Health Care Proxy and Living Will
A Health Care Proxy is a document in which you name someone (only one person may serve at a time) to make health care decisions on your behalf at any time you are incapable of making or communicating such decisions yourself. It can be revoked or revised at any time. Your health care proxy may also include a “living will” provision. This provision expresses your wishes as to whether you wish life prolonging medical procedures to be maintained even though there is no reasonable expectation that you will recover. It will help those entrusted with your medical care understand how you feel about the most critical medical care decision that someone may have to make for you. If you wish to have a Health Care Proxy, please list the name, residence, and relationship of your first and second choices:
Do you wish to include a “living will” provision? [ ] Yes [ ] No
FINANCIAL INFORMATION
Please describe assets as fully as possible.
Attach statements or other explanatory material where available.
* Circle 1 for Client 1, 2 for Client 2 and J for joint assets.
CASH AND BANK ACCOUNTS
Bank:
Account No.
Owner:
Type of Account:
Approximate Balance:
Bank:
Account No.
Owner:
Type of Account:
Approximate Balance:
Bank:
Account No.
Owner:
Type of Account:
Approximate Balance:
STOCKS, BONDS, MUTUAL FUNDS, BROKERAGE ACCOUNTS
Description:
Owner:
Approximate Value:
Description:
Owner:
Approximate Value:
Description:
Owner:
Approximate Value:
REAL ESTATE
Owner(s):
Address:
Mortgage:
Year Purchased:
Value:
Mortgage Balance:
Owner(s):
Address:
Mortgage:
Year Purchased:
Value:
Mortgage Balance:
Owner(s):
Address:
Mortgage:
Year Purchased:
Value:
Mortgage Balance:
LIFE INSURANCE
Company:
Policy No.:
Insured:
Owner:
Beneficiary:
Cash Value:
Death Value:
Loans Against:
Company:
Policy No.:
Insured:
Owner:
Beneficiary:
Cash Value:
Death Value:
Loans Against:
Company:
Policy No.:
Insured:
Owner:
Beneficiary:
Cash Value:
Death Value:
Loans Against:
Company:
Policy No.:
Insured:
Owner:
Beneficiary:
Cash Value:
Death Value:
Loans Against:
RETIREMENT PLANS, IRAs, PENSIONS, EMPLOYEE BENEFITS
Type of Plan:
Benefit Value:
Owner:
Beneficiary:
Approximate Value:
Type of Plan:
Benefit Value:
Owner:
Beneficiary:
Approximate Value:
Type of Plan:
Benefit Value:
Owner:
Beneficiary:
Approximate Value:
CLOSELY HELD BUSINESS INTERESTS
Name:
Percent Owned:
Type of Entity: [ ] LLC [ ] Corporation [ ] Partnership [ ] Sole Proprietorship
Names of Other Owners/Partners/Members:
Estimate of Value of Your Interest:
Do you have any plans to dispose of your business interest during your lifetime? [ ] Yes [ ] No
If Yes, please describe:
What are your wishes as to disposition of ownership of after your death?:
Transfer to Family?
Sale to Co-Owner of Business?
Sale to Key Employee?
Other?
Is there a Stockholder Buy/Sell Agreement? [ ] Yes [ ] No
MISCELLANEOUS ASSETS
Notes, Mortgages, Accounts Receivable Owed to You
Holder
Debtor
Type of Debt
Amount Owed
Personal Property (jewelry, paintings, collections, automobiles, boats, antiques, etc.)
Owner
Item
Approximate Value
Other
Owner
Item
Approximate Value
SUMMARY OF DEBTS (other than mortgages or loans against insurance)
Owner
Creditor
Approximate Amount
ADVISORS
Name
Address
Phone Number
Accountant:
Banker:
Financial Advisor:
Stockbroker:
Insurance Advisor:
Other Attorney:
Referral to This Office:
CURRENT DOCUMENTS
To the extent possible, please attach copies of the following documents or bring them to your initial estate planning meeting:
Wills and codicils, if any
Trust instruments in which you have an interest
All gift tax returns
Pre- or post-nuptial agreements
Separation Agreements, Divorce Papers
Life Insurance policies
Business agreements and documents regarding interests in closely-held business
Retirement plans or other information from plan administrator
Copyright © 2026 My Estate Advisors - All Rights Reserved.
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.