Estate Planning Questionnaire

Your Information

Name*

First Last

Email*

Address

Street Address Address Line 2 City State ZIP Code

Date of Birth

Citizenship

Home Phone*

Cellular

Work

Spouse Information

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Date of Birth

Citizenship

Home Phone

Cellular

Work

Current Estate Plan

Do you currently have a Will?*

Yes
No

Date of Will Self

Date of Will Spouse

Do you have a Living Trust?*

Yes
No

Date of Trust Self

Date of Trust Spouse

Are you the Beneficiary of someone else’s Trust?

Self Yes
Spouse Yes
No

Do you have a Living Will?

Self Yes
Spouse Yes
No

Have you named a health care representative?

Self Yes
Spouse Yes
No

Have you given someone a Power of Attorney?*

Yes
No

Name of Agent Self

Name of Agent Spouse

Is POA still in effect?

Self Yes
Spouse Yes
No

Note: If you have previously executed any of these documents, please bring them with you to your appointment.

Current Marriage

Date of Marriage

Marriage Location

Do you or your spouse have a prenuptial agreement and/or a formal property agreement?

Yes
No

Have you lived in any states, other than Washington, during your marriage?

Yes
No

Please list the state(s) and dates

Children from Current Marriage

Please list the full names of all children from your current marriage along with their dates of birth.

Children from Former Marriage

Please list the full names of all children from any former marriage along with their dates of birth.

Do you have any children who have passed away?

Yes
No

If so, did any deceased child leave a child who is still alive?

Yes
No

We will discuss the sections regarding Personal representatives, Guardians, and Trustees in our meeting with you. Please list your tentative choices below.

Personal Representative

(Carries out the terms of your will)

Personal Representative 1 Name

First Last

Personal Representative 2 Name

First Last

Personal Representative 3 Name

First Last

Trustee

(Administers any Trust established in your will)

Trustee 1 Name

First Last

Trustee 2 Name

First Last

Trustee 3 Name

First Last

Guardian/Conservator

(Cares for children under the age of 18, if both parents are deceased)

Guardian 1 Name

First Last

Guardian 2 Name

First Last

Guardian 3 Name

First Last

Attorney-In-Fact

(Handles your financial affairs, immediately or upon incapacity, as designated in the document)

Attorney-In-Fact 1 Name

First Last

Attorney-In-Fact 2 Name

First Last

Attorney-In-Fact 3 Name

First Last

Health Care Representative

(Makes health care decisions on your behalf if you are unable to do so)

Health Care Rep. 1 Name

First Last

Health Care Rep. 2 Name

First Last

Health Care Rep. 3 Name

First Last

Family Questions

Do you or your spouse have any health or disability concerns?

Does your child(ren) have any special education, medical or physical needs?

Do you provide primary or other financial support to any other adult children?

Is there any person other than your child(ren) who depend on you, wholly or partially, for current or future support?

Are you or your spouse making child support payments?

Are you or your spouse making payments pursuant to a divorce or property settlement?

If you or your spouse have been widowed, was a Federal Estate Tax or State Death Tax Return filed for the deceased spouse?

Have you or your spouse ever filed Federal or State Gift Tax returns?

Do either you or your spouse want specific Funeral Arrangements?

Are you or your spouse receiving Social Security, Disability, or other Governmental Benefits?

Are you or your spouse the beneficiary of a trust? If yes, please provide information about the Trust including the name of the Trust and any written documents you have and the name of the Trustee and Attorney for the trust, if you know.

Do you wish to disinherit someone other than your spouse, or disallow somebody from being your Attorney-in-Fact? If yes, please list their name(s).

Are you interested in hearing about a Pet Trust?

Yes
No

Property Information(Assets)

The following information about your property or properties, including the value and form of ownership will allow us to properly advise you regarding the estate planning options and tax planning strategies appropriate for you. Please fill in the information below in the categories that apply to you, as much as you can.

(NOTE: Indicating joint ownership presumes that the property passes to the joint owner by right of survivorship; please specify if your property is jointly owned but does not pass to the joint owner at death.)

Real Estate (equity only)

Owner

Value

Life Insurance - cash surrender value only; do not include term life insurance here

Owner

Value

IRA, 401(k), etc.

Owner

Value

Vehicles

Owner

Value

Business Interests

Owner

Value

Stocks & Bonds

Owner

Value

Pension Benefits that continue after your death

Owner

Value

Money owed to you (outstanding Notes payable to you)

Owner

Value

Other money & property

Owner

Value

Estate Plan

Specific Bequest

Do you wish to make any specific bequest in your Will? If yes, please fill in the information below; if no, please skip the rest of this section.

Car

Year, Make, Model

Beneficiary

Cash

Amount

Beneficiary

Other (for example – “wedding ring” or “all of my art work”)

Item	Beneficiary

Distribution of the Remainder of Your Estate

Who would you like to inherit the remainder of your estate when you die?

If the person(s) that you named above has predeceased you or the charity you chose is no longer in existence, who would you like to inherit the remainder of your estate when you pass away?

Sanders Law Group

Working for your Security, Independence and Peace of Mind

Sanders Law Group

Your Information

Spouse Information

Current Estate Plan

Current Marriage

Personal Representative

Trustee

Guardian/Conservator

Attorney-In-Fact

Health Care Representative

Family Questions

Property Information(Assets)

Estate Plan

Distribution of the Remainder of Your Estate