Personal Information Form Please enable JavaScript in your browser to complete this form.123456Subject Property AddressToday's DateYour Full Legal NameHome AddressAddress Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBest phone number to reach youEmailDate of BirthSend mail to:ResidenceBusinessNextChildrenAgeChildren AgeChildrenAgeChildren Age ChildrenAgePlease complete appropriate item(s):MarriedYesNoName of spousePrenuptial agreement?YesNoDivorcedYesNoDate divorce became finalWidowedYesNoDate of spouse's deathIf you are or have been married, please indicate whether you've ever lived in any of the following "community property" states.ArizonaCaliforniaColoradoIdahoLouisianaNevadaNew MexicoTexasPreviousNextPlease identify the professional advisors with whom you work (if any).AccountantAttorneyInsurance AgentInvestment Advisor / BrokerOtherDo you have a will?YesNoA living will?YesNoA trust of any kind?YesNoPowers of attorney?YesNoIf you have minor children, whom might you name as a guardian?Who or what professionals, close friends, or family might you name to handle your financial affairs (executor, trustee, agent under power of attorney)?Who might you name to make healthcare decisions for you?PreviousNextDo you have a safe deposit box?YesNoWhere is it located?Who has access to the box?Have you made any taxable gifts?YesNoIf so, when?Please provide a copy of each gift tax return. Click or drag a file to this area to upload. Please describe your disability coverage (if any).Are you a beneficiary of any trust currently in existence?YesNoAre you a trustee of any trust?YesNoPreviousNextPlease describe any wishes you might have regarding the handling of your person after your death (for example, cremation versus burial).Please describe any additional personal, family or financial circumstances or considerations that might impact or should be considered in evaluating your estate planning needs. These might include health concerns, adopted children, parents, siblings, or other family members with special needs, expected inheritances, and so on.Please list all real estate owned by you, the manner in which it is owned, and whether any other party has an ownership interest.Parcel addressTown, StateJoint or co-owner (describe)Parcel addressTown, StateJoint or co-owner (describe)Parcel addressTown, StateJoint or co-owner (describe)PreviousNextPlease describe as precisely as possible how you wish to distribute all your property upon death. (Property held jointly or in accounts with named beneficiaries will not pass through the will but according to the terms of ownership.)Please provide any additional information that could assist me in advising you.We often recommend that you execute a general power of attorney to appoint a representative to handle your affairs if you are unable to be physically present to manage them, or if you are temporarily or permanently incapacitated. Please list your primary and alternate choice for this person here.Primary choiceAlternate choiceIn some cases, we recommend that you consider a life estate deed to avoid probate and to assist with Medicaid planning (this is an additional cost). I recommend that we discuss whether or not this is a good fit for you.PreviousMessageSubmit
