Estate Planning Worksheet (Couple)

Please complete this questionnaire to the best of your ability and click submit so that we can review it prior to our meeting.

If you need assistance completing the information, call our office (845-255-4400) and we will help you.

This form is extremely important. Your accuracy and completeness in responding will help us to better assess your situation.

JUST DO THE BEST YOU CAN

If you prefer to print this form, please CLICK HERE to download a PDF.

Your Information
Todays Date
MM slash DD slash YYYY
Personal Data
Name
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
U.S. Citizen
- Yes
- No
Children
I have children
- YES
- NO
Name of Child
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
Name of Child 2
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
Name of Child #3
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
Name of Child #4
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
Name of Child #5
First Middle Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Birth Date
Important Family Questions:
Do you have a child that is a spendthrift?
- YES
- NO
Do you have a child with a learning disability?
- YES
- NO
Do any of your children receive governmental support or benefits?
- YES
- NO
Do you have any adopted children?
- YES
- NO
Do any of your children have special education, medical, or physical needs?
- YES
- NO
Do any of your family members have any problems with drug or alcohol addiction?
- YES
- NO
Are any of your children institutionalized?
- YES
- NO
Are you or your spouse receiving social security, disability, or other governmental benefits?
- YES
- NO
Do you provide primary or other major financial support to adult children?
- YES
- NO
Have either you or your spouse been divorced?
- YES
- NO
Are you making payments pursuant to a divorce or property settlement agreement? (Please furnish a copy when we meet.)
- YES
- NO
Have you or your spouse been widowed? (If a Federal estate tax or State death tax return was filed, please furnish a copy when we meet.)
- YES
- NO
Have you or your spouse completed previous Health Care Powers of Attorney or Living Wills? (Please furnish copies when we meet.)
- YES
- NO
Have you or your spouse completed previous wills, trusts, or estate planning? (Please furnish copies when we meet.)
- YES
- NO
Are you and your spouse United States citizens?
- YES
- NO
If you answered “NO,” are either you or your spouse a resident or a non-resident alien?
- YES
- NO
Does you have any children by a previous marriage?
- YES
- NO
Assets and Liabilities
Please insert the approximate value of each asset/liability in the appropriate space. If you prefer to print this form, please CLICK HERE to download a PDF.
Personal Effects/Household Items
Value - Spouse# 1 / Spouse #2
Joint
Liabilities
Automobile
Value - Spouse# 1 / Spouse #2
Joint
Liabilities
Checking Account
Value - Spouse# 1 / Spouse #2
Joint
Liabilities
Savings Account
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Money Market Accounts
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Certificates of Deposit
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Residence (Assessed Value)
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Other Real Estate
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Additional Automobiles
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Mutual Funds
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Stocks
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Bonds
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Annuities
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Cash Value - Life Insurance
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
IRA
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Other
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
Other
Value - Spouse# 1 / Spouse #2
Joint
Liabilites
What did you pay for your current home including any improvements
Address of any real property other than personal residence:
Address 1:
Street Address Address Line 2 City State ZIP Code
Tax Block # / Lot #:

Can be obtained from Tax Bill
Address 2:
Street Address Address Line 2 City State ZIP Code
Tax Block # / Lot #:

Can be obtained from Tax Bill
Address 3:
Street Address Address Line 2 City State ZIP Code
Tax Block # / Lot #:

Can be obtained from Tax Bill
Untitled
- First Choice
- Second Choice
- Third Choice

Estate Planning Worksheet (Couple)

Please complete this questionnaire to the best of your ability and click submit so that we can review it prior to our meeting.

Your Information

Personal Data

Children

Important Family Questions:

Assets and Liabilities

Address of any real property other than personal residence: