...
CONFIDENTIAL
ESTATE PLANNING QUESTIONNAIRE
FOR
A SINGLE PERSON
DATE:
Please
print or write legibly your answers to the questions.
If you need more space, use another sheet.
If you are not certain about an answer, leave the space
blank. Please bring
this questionnaire with you, or mail it to me, together with
copies of relevant deeds, insurance policies,
divorce/dissolution judgments, marital agreements, etc. at the
time of your appointment.
Home
Address and Telephone Number:
Name
as you sign it:
Full
name:
Date
and place of birth:
Social
security number:
Are
you a U.S. citizen?
Date
you came to California:
Business address and telephone
Children:
| Full
name |
Date
of Birth |
Address/Telephone
No. |
If
you have any deceased children, please list below:
| Name |
Date
of Death |
Names
of deceased child's children |
Names
and address of parents (if living):
If
you have any support obligation to your parents, please describe:
Names
and addresses of brothers and sisters:
List
amount of any gifts or inheritances you expect to receive from
parents and others:
Describe
any beneficial interests you have in a trust established by some
other person, describe any
powers
you have to designate who receives irrevocable trust property at
your death:
If
you are a custodian of property (under the California Uniform
Transfers and Minors Act or otherwise), or a trustee of property
for the benefit of your children or others, please describe:
Please
list any substantial gifts (over the annual exclusion of $10,000
or $11,000 per year) you have made to children or others:
Miscellaneous
Information.
a.
If you have a safe deposit box, give name and address of
bank and persons who have access:
b.
If you signed a buy/sell agreement concerning any
business interests, please
send a copy to Michael V. Vollmer.
c.
If you have a Will or Trust presently in existence,
please send them to Michael V. Vollmer or bring them with you to
your appointment.
Confidential
Asset List
As of (Date)
A. Real
estate: For each parcel, please list:
| Address |
type property |
value |
loan amount |
record title |
EXAMPLE:
123
Main Street
Orange, CA |
personal
residence |
$350,000 |
$150,000 |
joint
tenancy |
B. Promissory
notes owed to you
Name
of person who
owes you $ |
Secured?
(Yes or No) |
Amount
Owed to You |
How
do you hold
title? |
C. Securities
(stocks, bonds, partnerships)
Name
of Corporation
or Partnership |
Value |
Loans
Outstanding |
How
is Title Held? |
D. Closely
held business interests
| Value
of Your Interest |
Is
there a buy/ sell agreement? |
Name
of Entity |
How
is title held?
|
E. Employee
Benefits (pension plan, profit sharing plan, IRA, 40a(k), etc.
| Employer |
Type
of Plan (Pension/ Profit
Sharing/IRA) |
Name
of Employee |
Name
of Beneficiary
|
Present
Value |
F. Cash
and cash equivalents (checking accounts; certificates of
deposit, money market accounts, etc.)
| Name
of Institution |
Type
of Account |
How
is title held |
Amount |
G. Automobiles,
boats and other vehicles
| Year |
Make |
Present
Value |
Loans
owed |
How
is title held? |
H. Furniture,
furnishings, jewelry collections, etc.
| general
description |
value |
I. Life
insurance policies
| Name
of Company |
Policy
Number |
Name
of
Insured |
Name
of Owner |
.
.
| Face
Value |
Name
of Beneficiary |
Loans
owed
|
J.
Other assets (please describe and give value)
K. Liabilities
not shown above (please describe and give amount owed).
.
.
|
