607 Washington Street , Norwood, MA 02062
tel: 781.769.0070 fax: 781.769.3322
www.norwoodlawyers.com		  Robert E Grenham, Jr.
David M. Turchetta*
also admitted in RI, CT and NY

ESTATE PLANNING QUESTIONNAIRE

Effective estate planning requires that all relevant information concerning your personal, family and financial situation be assembled. This form as been prepared to aid you in organizing that information. If insufficient space is provided for any information, please include it on a separate sheet.

CONFIDENTIALITY; As is true in any communication between a lawyer and a client, the information reported here will be held in strictest confidence and released to no one without your prior consent.

FAMILY INFORMATION
   Yourself Spouse
Full Name    
Other names used    
Home address    
Social Security Number    
Home phone    
Occupation / Business    
Business address `
Business phone    
Date of birth    
Health    

CHILDREN
 Name  Date of Birth Social Security No. Address (if not home)
       
       
       

Should children who are born to you or adopted by you after the date of the will be included? yes no

ADOPTED OR STEP CHILDREN

 Name  Date of Birth Social Security No. Address (if not home)
       
       
       

OTHER BENEFICIARIES
(including parents, grandchildren, spouses of children, relatives or others you or
your spouse may desire to benefit).

 Name  Relationship Date of Birth Address (if not home)
       
       
       

OTHER CONSIDERATIONS
(please list prior marriages, support or settlement objections, marital agreement,
disabled children or beneficiaries).
 
 
 

Are either you or your spouse beneficiaries or trustees of any trust? _______________

Do you or your spouse anticipate receiving a substantial inheritance? _______________

IMPORTANT:

  • Prior Wills -- Please attach copies of all prior wills and trusts agreements of you and your spouse with this checklist if convenient. Otherwise, bring these documents to your conference.
  • Insurance Policies --Please attach copies of all life insurance policies of you and your spouse with this checklist if convenient. Otherwise, bring these documents to your conference.
  • Gift Tax Returns -- If you have ever filed any federal or state gift tax returns, please attach copies to this checklist if convenient. Otherwise, bring these documents to your conference.


FINANCIAL INFORMATION

Estimated Personal Balance Sheet

Directions Complete this form by supplying you best estimate of the fair market value of the categories of assets and liabilities listed below. If you have a recent personal financial statement, you may include that with this checklist and complete only those items below marked with an asterisk (*). With respect to real property (residence/vacation home or other real estate), please attach a copy of the deed by which you took title.

ASSETS
 Yourself Spouse Joint
Residence      
Other Real Property      
Bank Accounts      
Accounts Receivable, Notes payable to you      
Retirement Benefits      
Stocks/Bonds/Mutual Funds      
Automobiles      
Other (specify)      
Total Assets      

INSURANCE
Face Amount and Type Company Insured Beneficiary Owner
         
         
         
         

LIABILITIES
   Yourself Spouse Joint
Real Estate Mortgages      
Loans      
Other (specify)      
Total Liabilities      

Have you ever lived in or owned real estate in Arizona ( ), California ( ), Idaho ( ), Louisiana ( ), Nevada ( ), New Mexico ( ), Texas ( ), or Washington ( )?

Names and addresses of your financial advisors

   Name Address
Accountant    
Insurance Agent    
Broker / Trustee Investment Advisor    


ESTATE PLANNING PROVISIONS
 Personal Representative  Yourself Spouse
Primary (name and address)    
Successor (name and address)    

Guardians for your Minor Children  Yourself Spouse
Primary (name and address)    
Successor (name and address)    

Will your choice of guardian be affected by the marriage, divorce, remarriage or relocation of the persons named above? _______________

Disposition of Estate

What are your general desires as to the disposition of your estate? Indicate any specific gifts of items or cash you wish to make.

Describe Gift Name and Address of Recipient Relationship to Recipient

 

 

   

 

 

 

   

  

 

 

   

PREVIOUS GIFTS
(DO NOT INCLUDE GIFTS TO A CHARITY OR GIFTS OF LESS THAN $10,000)
Name of Recipient Nature of Gift Value Date of Gift Gift Tax Return Filed
         
         
         

Comments:
 
 
 


POWER OF ATTORNEY

Have you ever given a power of attorney to another? yes no
If yes, to whom and when?
 
 
 

   Yourself Spouse
Do you wish to be an organ/tissue donor?  yes no yes no 
If yes, have you signed an organ donor card or indicate on your driver's license that you intend to be an organ donor?  yes no yes no
Have you told your family about your intention to be an organ donor?  yes no yes no 
 Do you wish to leave instructions regarding burial or cremation?  yes no yes no 
Do you feel strongly about so-called "right to die" issues?  yes no yes no


©2000 Grenham and Turchetta, L.L.C.