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 form another source.

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.

Please summarize or provide copies of the following that may be applicable to your situation:

*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.

*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.

I. PERSONAL DATA

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

7. Prior Marriage:

Yes No

If yes, provide names of prior spouses and describe how prior marriage terminated.

8. Children (Put * beside stepchildren):

Full Name	Age	City/State

9. Employer

Hire Date

Retirement date

Occupation

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

Full Name	Age	Parents	City/State

11. When did you establish residency in North Carolina

12. Trace residences outside of North Carolina and approximate dates of each residency

13. 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.

14. 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)

15. Please list names and addresses of closest relatives other than children.

II. DISTRIBUTION OBJECTIVES

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

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

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

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

Name	Address	Amount

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

6. 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?

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

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

9. Are you interested in protecting your assets from the claims of your heir’s creditors? Yes No

10. Are you interested in protecting your assets in the event of a marriage dissolution? Yes No

In the event your heir’s marriage dissolves? Yes No

III. ADVISERS (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. Guardian for minor children

10. Substitute guardian for minor children

11. Investment adviser

12. Physician

13. Clergyman

14. Location of safe deposit

IV. YOUR ESTATE

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?

3. Do you have a Health Care Agent?

VI. INFORMATION REGARDING DISABLED DEPENDENTS, IF APPLICABLE

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.