Estate Planning Questionnaire – Powers of Attorney, Trusts, Wills, Beneficiary, Shareholder, IRA

Brady, Nordgren, Klym & Morton - Attorneys At Law

Estate Planning Questionnaire

Your Name (s):

From:

lawyers@bradynordgren.com

Date:

Re:

Estate Planning Information

The following information will provide facts about your estate as well as your desired disposition of your estate. It will assist in making recommendations of methods for carrying out your desires and planning for the reduction of taxes. Please fill out as much of the form as you can and note where your answers are incomplete. We will rely on your responses as to title ownership and value so please be accurate. Use extra pages if necessary. Some of the information requested will not apply to you. You may not know the answer to some of the questions, but please indicate where you think more information is available from another source.

When representing a married couple in an estate planning situation, we assume that the representation is joint and that all information given by either spouse may be freely shared among the three of us. We ask that each of you confirm his or her understanding of our sharing this information by signing the face of this questionnaire at the space indicated below. If either of you prefers that the representation be regarded as separate, with the result that the confidences imparted by each spouse separately will not be communicated to the other, please let us know as soon as possible so that we might all come to an agreement as to the effect of this decision.


Husband	Wife

Please be certain that you have confirmed the current ownership of any assets and the beneficiary designations of any retirement accounts or life insurance policies. We will not undertake an independent confirmation of your responses.

*Powers of Attorney you have signed. (Bring a copy)

*Trusts which you have created. (Bring a copy)

*Wills or trusts which name you as a beneficiary (if available).

*Partnership Agreements and Shareholder Agreements to which you may be a party.

*Qualified pension profit sharing plan or IRA benefits and current beneficiary designations.

*Life insurance policies and beneficiary designations.

*Real property owned by you or your spouse.

*Installment Sales Contracts to which you may be a party.

*Pre-nuptial Agreement, separation agreement, divorce decree or other documents of support obligation for former spouse or children. (Bring a copy)

I. PERSONAL DATA
Husband

1. Name

2. Address Home

(County of Residence)

Work

3. Date of birth

4. Social Security No.

5. Citizenship

If not U.S., then country of citizenship

6. Telephone: Work

Home

Fax

Cell

7. Prior Marriage:

Yes No If yes, provide names of prior spouses and describe how prior marriage terminated.

8. Date of current marriage

9. Children/Stepchildren (Put * beside stepchildren):

Full Name	Age	City/State

10. Employer:

Hire Date:

Retirement date:

Occupation

11. Grandchildren and their parents (Put * beside name if adopted):

Full Name	Age	Parents	City/State

12. When did you establish residency in North Carolina?

13.Trace residences outside of North Carolina during present marriage and approximate dates of each residency.

14. Is anyone dependent on you for support? If so, please identify the person and provide some general information as to the reason for and the extent of support provided and any special educational, medical, financial or personal needs that your children or these individuals may have in Section VI.

15. Have you made any gifts in excess of $10,000 to any one individual in any particular year.? Yes No
If yes, were gift tax returns filed. (Please provide copies)

16. Please list names and addresses of closest relatives other than children or spouse.

I. PERSONAL DATA
Wife

1. Name

2. Address Home

(County of Residence)

Work

3. Date of birth

4. Social Security No.

5. Citizenship

If not U.S., then country of citizenship

6. Telephone: Work

Home

Fax

Cell

7. Prior Marriage:

Yes No If yes, provide names of prior spouses and describe how prior marriage terminated.

8. Date of current marriage

9. Children/Stepchildren (Put * beside stepchildren):

Full Name	Age	City/State

10. Employer:

Hire Date:

Retirement date:

Occupation

11. Grandchildren and their parents (Put * beside name if adopted):

Full Name	Age	Parents	City/State

12. When did you establish residency in North Carolina?

13.Trace residences outside of North Carolina during present marriage and approximate dates of each residency.

15. Have you made any gifts in excess of $10,000 to any one individual in any particular year.? Yes No
If yes, were gift tax returns filed. (Please provide copies)

16. Please list names and addresses of closest relatives other than children or spouse.

II. DISTRIBUTION OBJECTIVES
Husband

1. Upon your death, describe generally how you want your assets distributed?

2. If you and your spouse both die prematurely, should your children receive property at majority (age 18), at age 21, or at a later age?

3. Do you want your spouse to manage your estate from an investment standpoint?

4. Is minimizing estate taxation of great importance to you?

5. Do you wish to make bequests to any charitable organization?

Name	Address	Amount

6. If none of your children are living when you and your spouse die, how should your estate be distributed?

7. If you own an interest in a business, is there a buy-sell agreement in effect? Do you desire your interest in that business to be distributed in a particular way?

8. Do you want specific assets (like jewelry, collections, furniture or heirlooms) to go to a specific person, charity or institution?

9. Are you willing to make any substantial gifts to reduce your estate?
and the tax on your estate?

10. Do you currently have a Power-of-Attorney?

11. Should you execute a Power-of-Attorney, should that agent be restricted in his or her authority to make gifts of your property to your spouse or descendants ?

12. Are you interested in protecting your assets from the claims of your heir’s creditors? YesNo

II. DISTRIBUTION OBJECTIVES
Wife

1. Upon your death, describe generally how you want your assets distributed?

2. If you and your spouse both die prematurely, should your children receive property at majority (age 18), at age 21, or at a later age?

3. Do you want your spouse to manage your estate from an investment standpoint?

4. Is minimizing estate taxation of great importance to you?

5. Do you wish to make bequests to any charitable organization?

Name	Address	Amount

6. If none of your children are living when you and your spouse die, how should your estate be distributed?

7. If you own an interest in a business, is there a buy-sell agreement in effect? Do you desire your interest in that business to be distributed in a particular way?

8. Do you want specific assets (like jewelry, collections, furniture or heirlooms) to go to a specific person, charity or institution?

9. Are you willing to make any substantial gifts to reduce your estate?
and the tax on your estate?

10. Do you currently have a Power-of-Attorney?

11. Should you execute a Power-of-Attorney, should that agent be restricted in his or her authority to make gifts of your property to your spouse or descendants ?

12. Are you interested in protecting your assets from the claims of your heir’s creditors? YesNo

III. FIDUCIARIES & ADVISERS - Husband (Names, city and telephone numbers, if available)

1. Attorney: Brady, Nordgren, Morton & Malone, PLLC, 2301 Sugar Bush Road,
Suite 450, Raleigh, NC 27612
Phone: 919-782-3500, Fax: 919-573-1430

2. Accountant

3. Life insurance agent

4. Banker

5. Executor of your estate

6. Substitute executor

7. Trustee

8. Substitute trustee

9. Attorney-in-Fact

10. Substitute Attorney-in-Fact

11. Health Care Agent

12. Guardian for minor children

13. Substitute guardian for minor children

14. Investment adviser

15. Physician

16. Clergyman

17. Location of safe deposit box

III. FIDUCIARIES & ADVISERS - Wife (Names, city and telephone numbers, if available)

1. Attorney: Brady, Nordgren, Morton & Malone, PLLC, 2301 Sugar Bush Road,
Suite 450, Raleigh, NC 27612
Phone: 919-782-3500, Fax: 919-573-1430

2. Accountant

3. Life insurance agent

4. Banker

5. Executor of your estate

6. Substitute executor

7. Trustee

8. Substitute trustee

9. Attorney-in-Fact

10. Substitute Attorney-in-Fact

11. Health Care Agent

12. Guardian for minor children

13. Substitute guardian for minor children

14. Investment adviser

15. Physician

16. Clergyman

17. Location of safe deposit box

IV. YOUR ESTATE
Husband

1. Have any gifts or inheritances been received by you or do you expect any in the future? If yes, please describe possibility and estimated value.

2. Do you own any "special" assets such as unique collections, family collections, antiques, art work or jewelry which require special consideration and valuation?

3. Are you the custodian or trustee over any assets belonging to others? Is there a substitute or successor custodian or trustee named? If yes, please explain.

4. List approximate value of property received by gift, inheritance or survivorship.

IV. YOUR ESTATE
Wife

1. Have any gifts or inheritances been received by you or do you expect any in the future? If yes, please describe possibility and estimated value.

2. Do you own any "special" assets such as unique collections, family collections, antiques, art work or jewelry which require special consideration and valuation?

3. Are you the custodian or trustee over any assets belonging to others? Is there a substitute or successor custodian or trustee named? If yes, please explain.

4. List approximate value of property received by gift, inheritance or survivorship.

PROPERTY

Ownership
S = Self
T = Trust

VERIFY ASSET OWNERSHIP
AND BENEFICIARY DESIGNATIONS

Family residence

Address

Estimated fair market value

Mortgage Balance

Year of purchase

Purchase price

General household furniture and furnishings

Household effects of special value (such as china, silver,
art works, antiques, jewelry, collections, etc.)
Estimated Value

Description

Automobile

Year

Make

Value

Loan Balance

Automobile

Year

Make

Value

Loan Balance

Other real estate

Address and description

Estimated fair market value

Mortgage balance

Year of purchase

Purchase price

Other real estate

Address and description

Estimated fair market value

Mortgage balance

Year of purchase

Purchase price

Checking, savings, and other accounts

Acct. No.	Bank/broker,etc.	Approximate balance

Brokerage Accounts

Firm	Broker's Name	Account #	Value

IRA's, 401 (k) plans, annuities, etc

Plan Sponsor	Beneficiary	Account balance


Note: Since each IRA custodian and 401(k) sponsor has unique agreements directing or limiting your payment options and beneficiary election options, please bring a copy of the custodial agreement, beneficiary designation and in the case of a 401(k) the summary plan description for each account or plan.

	Non-publicly traded business interests (such as closely held corporations, royalty rights, partnerships, etc.) Describe:
	Is this business an S-Corporation:
	Other assets, including any amounts owed to you (other than life insurance):
	Interests in trusts created by others (Bring copy of trust)

LIFE INSURANCE

List life insurance on you, specifying, for each policy, whether it is a whole life or term policy, the owner, beneficiary, on whose life the policy is written, the face amount of the policy, and its cash surrender value less outstanding loans) if any:

KIND (whole/term)	OWNER BENEFIC.	LIFE COVERED	FACE AMT	CASH VAL.

List your debts, if any, other than any mortgage on real property previously listed. Do not include consumer debt that will be paid off month to month.

TO WHOM?	AMOUNT DUE	SECURED BY

Are you the guarantor of the obligations of any other person or business? If yes, please describe.

CURRENT DEBTOR CREDITOR	MAXIMUM AMOUNT OWED	SUBJECT TO GUARANTY

V. FUNERAL ARRANGEMENTS AND DISPOSITION OF YOUR REMAINS

1. Do you have any special requests regarding funeral arrangements, burial, cremation or the disposition of your remains?

2. Do you have a Living Will?

Would you like to have a Living Will?

3. Do you have a Health Care Agent?

Would you like to have a Health Care Agent?

VI. DISABLED DEPENDENTS

If you have a dependent with a developmental disability, such as mental retardation, epilepsy, etc., or any other disability that requires special consideration, please request a supplemental questionnaire.