Michael J. Eschelbacher, Esq.
59 Federal Street
Salem, MA 01970
Telephone (978) 745-7456
Email: meschelbacher@mjeesq.com
ESTATE PLANNING QUESTIONNAIRE
In order to create an effective estate plan tailored to your personal circumstances, I need to assemble all of the relevant information concerning your biographical, family and financial situation. This form is intended to aid you in organizing that information in preparation for your first meeting with us.
CONFIDENTIALITY NOTE: As with all attorney-client communications, please note that any information you disclose to us orally or in writing will be held in the strictest confidence and released to no one without your consent.
I. PERSONAL/FAMILY INFORMATION
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| YOU | SPOUSE | ||
| Full Name | ||||
| Other Names Used | ||||
| Social Security No. | ||||
| Date of Birth | ||||
| U.S. Citizen? | ||||
| Health | ||||
| Home Address | ||||
| Home Phone | ||||
| Business/Occupation | ||||
| Business | ||||
| Address | ||||
| Business Phone | ||||
| Other Contact Information | ||||
| (e.g., Cellular phone, Email) | ||||
Send mail to: Home? [ ] or Business? [ ]
At what time of day and at what phone number do you prefer to be contacted?
| B. CHILDREN * | |||||||
| Date of | Social | ||||||
| Full Name | Birth | Security # | Address (if different from yours)
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| * Please note any stepchildren of either spouse. | |||||||
| C. OTHER BENEFICIARIES * | |||||||
| Date of birth | |||||||
| Full Name | Relationship | (if a minor) | Address | ||||
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| * E.g., parents, siblings, grandchildren, spouses/partners | |||||||
| of children, relatives, friends or others whom you or your | |||||||
| spouse might want to benefit. | |||||||
D. CHARITABLE BENEFICIARIES
Organization Name Charitable Mission/Purpose Address
E. TRUST INCOME/EXPECTANCIES
1. Are you or your spouse current beneficiaries or trustees of any trust? *
* Please bring a copy of any such trust(s) with you to the first meeting, if possible.
2. Do you or your spouse anticipate receiving an inheritance anytime soon?
F. PERSONAL REPRESENTATIVES
Consider the person(s) in your life who would be appropriate to serve as your personal representative(s) in the following roles: 1) Executor; 2) Trustee; 3) Health Care Agent; 4) Attorney-in-Fact, i.e., Financial Guardian; and/or 5) Guardian of any minor or special needs child/ren you may have. I will explain and discuss in depth these fiduciary designations at our first meeting.
II. FINANCIAL INFORMATION
Please list your estimate of the current fair market value of your assets and liabilities in the applicable categories below. If you would prefer, you may submit a copy of a recent personal financial statement that includes the requested information instead of completing this section.
A. ASSETS
| You | Spouse | Jointly Held | |||||||
| Property | |||||||||
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| Residence |
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| Other Real |
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| Property * |
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| Bank Accts, CDs & | |||||||||
| Money Market Funds |
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| Brokerage Accts & | |||||||||
| Individual Stocks, | |||||||||
| Bonds, Mutual | |||||||||
| Funds |
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| Retirement Benefit | |||||||||
| Plans (e.g., |
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| Pension, 401ks, | |||||||||
| IRAs, SEP-IRAs, | |||||||||
| Keogh Plans) | |||||||||
| Other Corporate | |||||||||
| Benefit Plans | |||||||||
| (e.g., Stock | |||||||||
| Options, Profit | |||||||||
| Sharing) | |||||||||
| Closely Held | |||||||||
| Business | |||||||||
| Interests ** | |||||||||
| (e.g., S.Corp, | |||||||||
| LLC, Partnership) |
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| Annuities, Notes | |||||||||
| & Other | |||||||||
| Receivables | |||||||||
| Miscellaneous | |||||||||
| Assets | |||||||||
| (a) Automobiles |
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| /Boats |
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| (b) Household/ | |||||||||
| Personal | |||||||||
| Property | |||||||||
| (c) Other | |||||||||
| (e.g., | |||||||||
| Antiques, | |||||||||
| Art, Jewelry, | |||||||||
| etc.) | |||||||||
| Life Insurance | |||||||||
| (Note: 1) Type of | |||||||||
| Insurance--e.g., | |||||||||
| Term, Whole, |
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| Individual, Group, |
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| etc.; 2) Ins. Co.; |
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| 3) Policy Owner; |
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| & 4) | |||||||||
| Beneficiary/ies) | |||||||||
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| * Have you ever lived in or owned real estate in one or more of the following | |||||||||
| Community Property states: Arizona [], California [], Idaho | |||||||||
| [], Louisiana [], Nevada [], New Mexico [], Texas [], | |||||||||
| Wisconsin [] or Washington []? ** Buy-Sell Agreement in place? ___ Yes ____No | |||||||||
| C. LIABILITIES | |||||||||
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| Property | |||||||||
| Real Estate Mortgage # 1 |
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| Real Estate Mortgage # 2 | |||||||||
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| Loans, Notes & |
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| Personal Guarantees | |||||||||
| Other Debts & Liabilities Credit Card Balances | |||||||||
| Divorce Payment/ | |||||||||
| Transfer Obligations | |||||||||
| (Current or Post-Death) |
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| D. OTHER FINANCIAL ADVISORS * | |||||||||
| Accountant | |||||||||
| Insurance Agent | |||||||||
| Broker/Trustee/ | |||||||||
E. ADDITIONAL DOCUMENTS
Along with this questionnaire or other personal financial statement you may bring to our first meeting, it may be helpful for you to bring copies of certain additional legal or financial documents--if it is convenient for you to readily assemble them. Such documents would include any or all of the following documents, as applicable to your situation:
1) Existing Wills or Trusts;
(including any trust created by another on which you are a beneficiary)
2) Real Estate Deeds;
3) Investment or Retirement Plan Statements;
4) Gift Tax Returns Previously Filed;
5) Most Recent Income Tax Return;
6) Any Current Prenuptial or Prior Divorce Agreements;
7) Any Relevant Closely Held Business Financial Statements or Agreements.
Thank you for your time and preparation. I look forward to meeting with you.