Estate Planning Worksheet

MacGeorge Law Firm, PLLC

Estate Planning and Administration

USING THIS ORGANIZER WILL ASSIST US IN DESIGNING AN ESTATE PLAN THAT MEETS YOUR GOALS. ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.

IF POSSIBLE, PLEASE RETURN THE COMPLETED WORKSHEET TO OUR OFFICE PRIOR TO YOUR APPOINTMENT VIA MAIL OR FAX.

Part I

Personal Information

(name most often used to title property and accounts)

^•First Name

Last Name

(other names used to title property and accounts)

Also Known As

Prefer to be called

Birth date

SS#

US Citizen?

Home Address

City

State

Zip

Home Telephone

County of Residence

Business Telephone

Employer

Position

Business Address

City

State

Zip

E-mail Address

It is okay to communicate with me via my E-mail address

Date of Marriage

Client's Spouse or Second Grantor’s Legal Name (name most often used to title property and accounts)

Also Known As (other names used to title property and accounts)

Prefer to be called

Birth date

SS#

US Citizen?

Home Address

City

State

Zip

Home Telephone

County of Residence

Business Telephone

Employer

Position

Business Address

City

State

Zip

E-mail Address

It is okay to communicate with me via my E-mail address

Children and Other Family Members

(Use full legal name. Use “JT” if both spouses are the parents, “1” if client or first listed grantor is the parent, “2” if spouse or second listed grantor is the parent, “S” if a single parent.)

Name

Birth date

Parent or Relationship

Comments:

Name

Birth date

Parent or Relationship

Comments:

Name

Birth date

Parent or Relationship

Comments:

Name

Birth date

Parent or Relationship

Comments:

Name

Birth date

Parent or Relationship

Comments:

Name

Birth date

Parent or Relationship

Comments:

Advisors

Name

Personal Attorney

Telephone

Accountant

Telephone

Financial Advisor

Telephone

Life Insurance Agent

Telephone

Your Concerns

Please rate the following as to how important they are to you:

( H high concern, S some concerned, L low concern, N/A no concern or not applicable)

Description

Level of Concern

Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.

Client

Spouse

Providing for and protecting a spouse.

Client

Spouse

Providing for and protecting children.

Client

Spouse

Providing for and protecting grandchildren.

Client

Spouse

Disinheriting a family member.

Client

Spouse

Providing for charities at the time of death.

Client

Spouse

Plan for the transfer and survival of a family business.

Client

Spouse

Avoiding or reducing your estate taxes.

Client

Spouse

Avoiding probate.

Client

Spouse

Reduce administration costs at time of your death.

Client

Spouse

Avoiding a conservatorship (“living probate”) in case of a disability.

Client

Spouse

Avoiding will contests or other disputes upon death.

Client

Spouse

Protecting assets from lawsuits or creditors.

Client

Spouse

Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.

Client

Spouse

Plan for a child with disabilities or special needs, such as medical or learning disabilities.

Client

Spouse

Protecting children’s inheritance from the possibility of failed marriages.

Client

Spouse

Protect children’s inheritance in the event of a surviving spouse’s remarriage.

Client

Spouse

Provide that your death shall not be unnecessarily prolonged by artificial means or measures.

Client

Spouse

Other Concerns (Please list below):

Describe

If so, please explain below.

Additional Information

Click here if you would like to begin Part II: Property Information (you can submit and come back to these later)

Part II

Property Information

Instructions for completing the Property Information checklist:

General Headings This Property Information checklist helps you list all the property you own and what it is worth. If you do not own property under a particular heading, just leave that section blank. Under certain headings, you may own more property than can be listed on this checklist. If so, attach extra sheets of paper to list your additional property.

Type Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading.

“Owner”of Property How you own your property is extremely important for purposes of properly designing and implementing your estate plan. For each property, please indicate how the property is titled. When doing so, please use the following abbreviations:

Owner of Property	Use
If married, Client’s name alone, with no other person	C
If married, Spouse’s name alone, with no other person	S
If married, Joint Tenancy with spouse	JTS
Joint Tenancy with someone other than a spouse, i.e. a child, parent, etc.	JTO
If you cannot determine how the property is owned	?

Real Property

TYPE: Any interest in real estate including your family residence, vacation home, timeshare, vacant land, etc.

General Description and/or Address

Owner

Market Value

Loan Balance

General Description and/or Address

Owner

Market Value

Loan Balance

General Description and/or Address

Owner

Market Value

Loan Balance

Total of Market Value

Total of Loan Balance

Furniture and Personal Effects

TYPE: List separately only major personal effects such as jewelry, collections, antiques, furs, and all other valuable non-business personal property (indicate type below and give a lump sum value for miscellaneous, less valuable items.).

Type or Description Miscellaneous Furniture and Household Effects (Total)

Owner

Market Value

Type or Description Miscellaneous Furniture and Household Effects (Total)

Owner

Market Value

Type or Description Miscellaneous Furniture and Household Effects (Total)

Owner

Market Value

Type or Description Miscellaneous Furniture and Household Effects (Total)

Owner

Market Value

Type or Description Miscellaneous Furniture and Household Effects (Total)

Owner

Market Value

Total

Automobiles, Boats, and RVs

TYPE: For each motor vehicle, boat, RV, etc. please list the following: description, how titled, market value and encumbrance:

Bank Accounts

TYPE: Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s here

Name of Institution and account number

Type

Owner

Amount

Name of Institution and account number

Type

Owner

Amount

Name of Institution and account number

Type

Owner

Amount

Name of Institution and account number

Type

Owner

Amount

Name of Institution and account number

Type

Owner

Amount

Name of Institution and account number

Type

Owner

Amount

Total

Note: If Account is in your name (or your spouse’s name) for the benefit of a minor, please specify and give minor’s name.

Stocks and Bonds

TYPE: List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. (indicate type below)

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Stocks, Bonds or Investment Accounts

Type

Acct. Number

Owner

Amount

Total

Life Insurance Policies and Annuities

TYPE: Term, whole life, split dollar, group life, annuity. ADDITIONAL INFORMATION: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent.

Total

Retirement Plans

TYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K). ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.

Total

Business Interests

TYPE: General and Limited Partnerships, Sole Proprietorships, privately-owned corporations, professional corporations, oil interests, farm, and ranch interests. ADDITIONAL INFORMATION: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

Total

Money Owed To You

TYPE: Mortgages or promissory notes payable to you, or other moneys owed to you.

Name of Debtor

Date of Note

Maturity Date

Owed to

Current Balance

Name of Debtor

Date of Note

Maturity Date

Owed to

Current Balance

Name of Debtor

Date of Note

Maturity Date

Owed to

Current Balance

Name of Debtor

Date of Note

Maturity Date

Owed to

Current Balance

Total

Anticipated Inheritance, Gift, or Lawsuit Judgment

TYPE: Gifts or inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

Description

Total estimated value

Other Assets

TYPE: Other property is any property that you have that does not fit into any listed category.

Type

Owner

Value

Type

Owner

Value

Type

Owner

Value

Type

Owner

Value

Type

Owner

Value

Total

Summary of Values

Assets

Amount*

Real Property

Client

Spouse

Total Value

Furniture and Personal Effects

Client

Spouse

Total Value

Automobiles, Boats and RV’s

Client

Spouse

Total Value

Bank and Savings Accounts

Client

Spouse

Total Value

Stocks and Bonds

Client

Spouse

Total Value

Life Insurance and Annuities

Client

Spouse

Total Value

Retirement Plans

Client

Spouse

Total Value

Business Interests

Client

Spouse

Total Value

Money owed to you

Client

Spouse

Total Value

Anticipated Inheritance, Etc.

Client

Spouse

Total Value

Other Assets

Client

Spouse

Total Value

* Joint Property values enter 1/2 in client’s column and 1/2 in spouse’s column.

Click here if you would like to begin Part III: Design Information

Part III

Design Information

PERSONS TO ACT FOR YOU:

GUARDIAN FOR MINOR CHILDREN: If you have any children under the age of 18, list in order of preference who you wish to be guardian.

Name and Address

Relationship

Name and Address

Relationship

INITIAL TRUSTEE(S): Usually the Maker will be the Trustee of his or her own trust. Often, both spouses, jointly. Allows you to continue to jointly control your assets as before

Name and Address

Relationship

Name and Address

Relationship

DISABILITY TRUSTEE: If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your property and assets?

FOR CLIENT

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

FOR SPOUSE

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

DEATH TRUSTEE: After your death, who do you want carrying out your instructions, for distribution to and, if desired, management of property for your beneficiaries?

FOR CLIENT

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

FOR SPOUSE

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

Name and Address

Relationship

POWER OF ATTORNEY: If you were unable to make financial decisions for yourself, who would you want to make those decisions for you?

CLIENT’S AGENT

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

SPOUSE’S AGENT

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Do you want to authorize your Financial Agent to make gifts on your behalf during any period of time you are incapacitated?

Gifting Power Details:

LIVING WILL

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Do you want to provide that your organs and tissues should be made available for transplant purposes?

HEALTH CARE

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?

CLIENT’S AGENT

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

SPOUSE’S AGENT

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Name

Relationship

Instructions or Guidelines

Do you want to authorize your Medical Agent to take whatever steps are necessary to keep you in a personal residence rather thannursinghome?

Do you want to provide that upon certification by 2 physicians of need for psychological or substance treatment, Agent may arrange for voluntary admission?

DISTRIBUTIONS OF PERSONAL PROPERTY AND SPECIFIC GIFTS

USE OF PERSONAL PROPERTY MEMORANDUM:

Any property not listed on the memorandum should be distributed to:

List on next line

SPECIFIC GIFTS: List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities. Indicate whether these gifts are to be made even if the other spouse is alive.

FOR CLIENT:

Individual or Charity

Amount or Property