Estate Planning Worksheet

Your name*

Email address*

Phone*

County of residence

Home address (Street address, City, State, Zip)

Husband's Information

Husband's legal name

Name husband usually uses to sign legal documents

Husband's date of birth

Husband's social security number

Husband's driver's license number

U.S. citizen?

Yes

Wife's Information

Wife's legal name

Name wife usually uses to sign legal documents

Wife's date of birth

Wife's social security number

Wife's driver's license number

U.S. citizen?

Yes

Date of marriage

Marriage status

Married

Divorced

Widowed

Single

Children and/or other family members

Use full legal names, complete addresses and dates of birth. (Use “JT” if both spouses are the parents, “H” if husband is the parent and “W” if the wife is the parent.)

Child's full legal name

Address

Date of birth

JT/H/W

Trustees/Executors/Financial Agents

Your trustees/executors/financial agents will be the people who will make choices for you after your death and if you become unable to make choices for yourself. Your spouse will usually be your first successor trustee. List at least 2 additional trustees/executors/financial agents.

Name

Address

Phone

Health Care Agents

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment?

Name

Address

Phone

Guardian for Minor Child(ren)

If you have any children under the age of 18, list in order preference who you wish to be guardian. It is usually wise to choose someone other than a Trustee/Executor for this responsibility.

Name and address

Relationship

Beneficiaries

Beneficiary name

How much (1/2, 1/3, 1/4...)

Distribute outright to our beneficiaries

Structured trust

Structuring the trust for beneficiaries may cause the price of the trust to increase.

Specific Distributions: (Charities or Individuals who receive gifts prior to those beneficiaries named or those you would like to receive specific property or gifts)

How and when to distribute my property after specific distributions are made:

Remote Contingent Beneficiaries

Who do you want to receive your property in the unlikely event that no one listed above is alive to receive your property?

To each spouse’s heirs-at-law

One-half to Husband’s heirs-at- law and one-half to Wife’s heirs-at-law

To the following named individuals and/or charities

Please specify:

Do you possess a Power of Appointment (or the right to determine how another’s property is disposed)?

Yes

Please explain:

Include a copy of the document granting power:

Real Property

Property address

Homestead property

State

Owner

Private or Small Business Interests

Such as: general and limited partnerships, sole proprietorships, privately owned corporations, professional corporations, oil interests, farm and ranch interests.

Do you wish to disinherit anyone? If so, who, and what is his or her relationship to you?

Do any of your beneficiaries have special educational, medical or physical needs? On SSI, SSDI or Medicaid?

Additional information:

Assets

Checking and Savings Accounts

Description

Current Value

Interest Rate

Total value

CD's and Money Market Accounts

Description

Current Value

Interest Rate

Total value

Stocks, Bonds and Mutual Funds

Description

Current Value

Interest Rate

Total value

Retirement Accounts

IRA, 401-K, TSA or other Accounts

Description

Current Value

Interest Rate

Life Insurance/Annuities

Description

Current Value

Interest Rate

Income Sources

Social Security:

Pensions:

Investments:

Rents:

Other:

Type the characters*

This field should be left blank

(855) 904-REAP

info@retirementestateplan.com

Estate Planning Worksheet

Husband's Information

Wife's Information

Children and/or other family members

Trustees/Executors/Financial Agents

Health Care Agents

Guardian for Minor Child(ren)

Beneficiaries

Remote Contingent Beneficiaries

Real Property

Private or Small Business Interests

Assets

Checking and Savings Accounts

CD's and Money Market Accounts

Stocks, Bonds and Mutual Funds

Retirement Accounts

IRA, 401-K, TSA or other Accounts

Life Insurance/Annuities

Income Sources