Checklist for Preparing Your Estate Plan
The following checklist can be printed and used as an estate-planning tool. Please note that this checklist or your use of it does not create an attorney-client relationship with the Law Offices Of Georgia N. Kezios. The purpose of this checklist is: (1) to help you organize your personal and financial information so you can assess your current estate plans and evaluate whether changes are desired or required; (2) to provide my office with the information necessary for a similar analysis should you choose to hire me to prepare your estate plan; and (3) to help you evaluate my estate planning recommendations should you choose to retain my services. Please provide information that is as accurate as possible. For example, if you are unsure about exact information, you should tell me and give me the best possible assessment. When more exact information is required, you will need to be more precise. Some of these questions may require additional room, please feel free to elaborate on any question either on the backside of the checklist or on separate paper. You may provide as much or as little information as you want, as the questionnaire is fairly intrusive. Keep in mind, however, that the more complete the information, the better it will equip both you and me throughout the planning process. Full Name:_________________________________________ Nickname(s): ______________________________________ County of Residence:_________________________________ Home Address:____________________________ Phone: ________
_____________________________ Occupation: _______________________________________ Employer: _________________________________________ Business Address:_________________________ Phone: _________ Prefer to be called:_____Home ____Office Prefer correspondence sent:_____ Home ___Office Place of Birth:____________________________________ Date of Birth:____________________________________ Social Security Number:____________________________ Married: _____Yes _____No If married, complete the following for spouse: Full Name:______________________________________ Business Address:________________________________ Phone:___________
________________________________ Place of Birth:___________________________________ Date of Birth:____________________________________ Social Security Number:___________________________ If presently not married, indicate whether:
___ never married
___ previously married If married previously, indicate whether:
___ prior marriage ended in divorce
___ prior marriage ended with death of spouse If spouse was previously married, indicate whether spouse's prior marriage ended by: ____ death
____ divorce Complete the following for each of your children: Full Name
___________________
___________________
___________________
___________________
___________________
Date Of Birth
_____________
_____________
_____________
_____________
_____________
Address (if not at home)
________________________________
________________________________
________________________________
________________________________
________________________________
Do you or your spouse have any children born prior to marriage or by a previous marriage? ____Yes ____No Indicate which, if any, of your children is your child but not your spouse's, or vice versa. Also please show the date of adoption of any adopted child. Be sure to include any deceased child and indicate the date of the child's death and his or her surviving spouse and children. Does spouse or any child have any physical, mental, or emotional disability? _____ Yes _____No Is there other important personal information that might affect your estate plans? For example, does a member of your family have a serious long-term medical or physical problem that will require special care or attention in the future? Personal and family financial assets (list on additional paper if necessary): With regard to real estate, it is important that I know: - The location (city and state) of the real estate
- How title is held
- The character of the property (i.e., shopping center, apartment house, or similar description)
Personal residence - Address
- Description (i.e., single-family, condo, or similar description)
- How do you hold title (joint tenancy or tenants in common)
- Fair market value
- Mortgage balance, if any
- Do you have mortgage life insurance?
Other personal residences or vacation homes: - Address
- Description
- How do you hold title (joint tenancy or tenants in common)
- Fair market value
- Mortgage balance, if any
- Do you have mortgage life insurance?
Community property: If you live in or have lived in Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, or Washington, or own real estate in any of these states: a. Indicate which state
b. Indicate whether you and your spouse have entered into any agreement about whether that property is separate property
Personal and household effects (If you think that the general categories do not provide an adequate description, please provide additional detail, also stating your best estimate of the value of each kind of property and who owns it): - Automobiles
- General personal household effects such as furniture, furnishings, books, and
- pictures of no special value
- Valuable jewelry (indicate if insured)
- Valuable works of art (indicate if insured)
- Valuable antiques
- Other valuable collections (i.e., coins, stamps, or gold)
- Other tangible personal property that does not seem to be covered by any of the other categories)
Cash, cash deposits, and cash equivalents (show who owns each item): - Checking accounts, including money market accounts:
a. You
b. Spouse
c. Other joint owners
- Ordinary savings accounts:
a. You
b. Spouse
c. Other joint owners
- Certificates of deposit:
a. You
b. Spouse
c. Other joint owners
- Short-term U.S. obligations (T-bills):
a. You
b. Spouse
c. Other joint owners
Pension and profit-sharing plans, IRAs, ESOPs, or other tax-favored employee benefit plans
- Pension plans:
a. You; date vested; current value
b. Spouse; date vested; current value
- Profit-sharing:
a. You; date vested; current value
b. Spouse; date vested; current value
- Other tax-qualified employee benefit plan interests (please provide similar information to above)
Life insurance on your life - Ordinary life insurance:
a. Face amount of policies (proceeds)
b. Owner, if not you
c. Beneficiaries
d. Cash value
e. Loans, if any, against it
f. Amount of accidental death benefits, if any
- Term/group insurance:
a. Face amount of policies
b. Owner other than you
c. Beneficiaries
d. Accidental death benefits
- Please supply similar information with respect to other life insurance or other insurance having life insurance features.
Life insurance on your spouse's life
- Ordinary life insurance:
a. Face amount of policies
b. Owner other than spouse
c. Beneficiaries
d. Cash value
e. Loans, if any
f. Accidental death benefits
- Term/group insurance
a. Face amount of policies
b. Owner other than spouse
c. Beneficiaries
d. Cash value
e. Loans, if any
f. Accidental death benefits
- Other insurance on spouse's life
Closely held business interests - Describe any interest you have in a family or other business with limited shareholders, including:
a. The nature of the business
b. Its form of organization (i.e., corporation, partnership, or the like)
c. Whether you are active in its operations
d. Your estimate of its value
e. If it is a corporation, please indicate whether an "S election" is in force with respect to the corporation
- With respect to any such business, do you believe it would continue to operate successfully in the event of your permanent absence from it or the permanent absence of some other key person?
Investment assets (with respect to each category, please state the owner (how title is held) and the approximate value):
- Publicly traded stocks and corporate bonds:
a. You
b. Spouse
c. Other joint owners
- Municipal bonds:
a. You
b. Spouse
c. Other joint owners
- Long-term U.S. Treasury Notes and Bonds:
a. You
b. Spouse
c. Other joint owners
- Limited partnership interests:
a. You
b. Spouse
c. Other joint owners
- Other investments (Please describe the general nature and value of other investment interests):
a. You
b. Spouse
c. Other joint owners
Interests in trusts: - Describe any trusts created by you or by any other person, such as a parent or ancestor, in which you or a member of your immediate family have a right to receive distributions of income or principal, and whether such distributions are actually being received or are anticipated in the future being as specific as you can.
- If possible, attach a copy of the trust agreement.
- If the trust agreement is not available, show:
a. The date the trust was created
b. Whether it can be amended or changed
c. Whether someone has a power of appointment over it
d. When the trust terminates
e. Who will receive the trust property on termination
f. The approximate current value of the trust and the annual income from it
Anticipated inheritances: - If you or any other members of your immediate family are likely to receive substantial inheritances in the foreseeable future from persons other than you or your spouse, describe your best estimate of the value and nature of each inheritance.
Other assets or interests of value: - Describe the general nature, form of ownership, and your estimate of the value of any asset or interest of value that does not seem to fit in any of the categories above.
Liabilities: - Describe here any substantial financial liabilities not reflected in the asset information provided above.
- If they are secured, indicate the nature of the security.
- Show any substantial contingent liabilities, such as personal guarantees you have made on obligations of a business, a family member, or any other person.
- Indicate whether you have insured against any of these obligations in the event of your death, or if the obligations do not survive your death.
Personal estate planning objectives: State who you want your assets to go to upon your death: First Choice of Disposition: Second Choice of Disposition: Any Charitable Preferences: If there are no living heirs upon your death, who do you want to have your assets? Personal Representative. Who do you want to have wind up your affairs at your death? That would include: seeing to it that your assets are collected; that claims, expenses, and estate and inheritance taxes are paid; and final distribution of your property to beneficiaries, trustees or others you have named is a task of limited duration, substantial responsibility, and much work. Name, address and telephone number of each individual you would like to serve as personal representative of your estate: 1st choice: ____________________________________ 2nd choice: ____________________________________ 3rd choice: ___________________________________ Do you want your personal representative to be reimbursed for the time they spend on administering your estate? _____Yes _____No Do you want your personal representative to be reimbursed for expenses (i.e., travel expenses, etc.) that is spent in order to administer your estate? _____Yes _____No Do you want your personal representative to be required to serve with a bond or without a bond? _____Yes _____No Guardians for minor children. If you have minor children, who do you want to take care of your children in the event of your death and/or your spouse's death? Name, address and telephone number of each individual you would like to serve as guardian of your minor child(ren): 1st choice: ______________________________________ 2nd choice: __________________________________ 3rd choice: ______________________________________ Trustees. This person has the responsibility for the long-range management of property that is to be held in trust for the benefit of beneficiaries of trusts you may create. Depending on the terms of the trust, there may be adverse tax consequences if a trustee has an interest or possible interest in the trust, although, usually if the trustee's discretion is limited, those adverse tax consequences are similarly limited. Trustees can be corporations (qualified to act) or individuals. You may choose to have co-trustees, one of which may or may not be a corporation. In general, choose a trustee with the following qualities: integrity, mature judgment, fiscal responsibility, and reasonable business and investment acumen. If you wish to select co-trustees, you may want to choose them for how well their individual strengths complement one another. Name, address and telephone number of each individual you would like to serve as trustee: 1st choice: _________________________________________ 2nd choice: __________________________________ 3rd choice: __________________________________ Are there any facts or matters that do not seem to be covered above? If so, please comment here: Powers of attorney: - Have you given power of attorney to your spouse, a child, or any other person, authorizing that person to do either specific things on your behalf or to act generally on your behalf? If so, indicate:
a. To whom it was given
b. The nature of the power (specific or general)
c. The date
d. The location of the document granting the power
- 'If not, would you like to do so?
- Who do you want to give authorization to?
Living will: - Have you signed any document indicating your wishes regarding "heroic" or extraordinary measures to save your life in the event of a catastrophic illness or injury?
- If not, would you like to do so?
Medical Power of Attorney: - Have you signed any document specifically authorizing another person such as your spouse to make decisions with respect to your healthcare in the event you are unable to do so?
- If not, would you like to do so?
- Who do you want to give authorization to?
Do you understand that I am not a tax expert and that in preparing your will I do not give tax advice? _____ Yes _____ No Do you understand that if your estate is worth more than $675,000 there may be serious tax implications and you should seek the services of a tax attorney in preparing your will?
_____ Yes _____ No If your estate is worth more than $675,000 and you choose not to execute trusts and related estate planning documentation appropriate for that size of estate, do you understand that there may be serious tax implications as a result of your decision not to plan accordingly? _____ Yes _____ No Date this checklist was completed? ________________ ______________________________
Signature The Law Offices of Georgia N. Kezios 9928 East Flower Street
Suite 201
Bellflower, CA 90706 Phone: 562-263-0232
562-622-6430
Fax: 562-263-0234
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