Married Person Intake Worksheet

Married Person Intake Worksheet
INSTRUCTIONS

USING THIS ORGANIZER WILL ASSIST US IN DESIGNING AN ESTATE PLAN THAT MEETS YOUR GOALS. ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL AND IS SECURELY ENCRYPTED. IF YOU ARE UNABLE TO UNDERSTAND VARIOUS SECTIONS OF THIS ORGANIZER, YOU MAY LEAVE THOSE SECTIONS BLANK. YOU WILL BE UNABLE TO SAVE YOUR ANSWERS AS YOU FILL OUT THE FORM. THEREFORE, IF YOU CLOSE YOUR BROWSER OR LOSE THE INTERNET CONNECTION BEFORE HITTING THE "SUBMIT" BUTTON AT THE END OF THE FORM, YOUR WORK WILL BE LOST. TO AVOID THIS OUTCOME, YOU CAN: 1) FILL OUT PORTIONS OF THE FORM (EXAMPLE: ENTER 1/2 OF THE REQUESTED INFO THEN HIT "SUBMIT" THEN GO BACK AND ENTER THE OTHER 1/2 OF THE REQUESTED INFO, THEN HIT "SUBMIT" SO THAT YOU SUBMIT THE DATA IN TWO OR MORE BATCHES); 2) REVIEW THE FORM IN ADVANCE AND MAKE SURE YOU HAVE ALL OF THE REQUESTED DATA BEFORE ENTERING IT; 3) DON'T USE THIS WEB SUBMISSION FORM AND INSTEAD USE THE FILLABLE PDF FORM LOCATED ON THE RESOURCES PAGE OF OUR WEBSITE. ONCE YOU HAVE COMPLETED THIS FORM, HIT "SUBMIT" TO SEND THE INFORMATION TO OUR OFFICE. A COPY OF YOUR SUBMISSION WILL BE EMAILED TO YOU.
PERSONAL INFORMATION

For purposes of this data organizer, one spouse should be designated as "Spouse-A" and the other spouse should be designated as "Spouse-B. You may decide which spouse is designated accordingly.
Spouse-A’s Legal Name*

First NameMiddle NameLast Name
Also Known As (other names used to title property and accounts)
Sign as (i.e., John P. Doe)*
Prefer to be called
Birth Date
Social Security # (last four digits only)
US Citizen?
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of residence
Home Phone Number

Area CodePhone Number
Business Phone Number
Employer
Position
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
It is okay to contact me via phone or email

YesOther
Date and Place [city/township] of Marriage
Spouse-B’s Legal Name*

First NameMiddle NameLast Name
Also Known As (other names used to title property and accounts)
Sign as
Prefer to be called
Birth Date
Social Security #
US Citizen?
Home Address (if different from Spouse-A's address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of residence
E-mail
It is okay to contact me via phone or email

YesOther
Current or Intended Location of Storing Estate Planning Documents (i.e., bank safe deposit box or home safe/cabinet
Preferred Name of Living Trust (if applicable) (i.e., Doe Family Trust)
CHILDREN AND/OR OTHER FAMILY MEMBERS

(Use full legal name, enter in birth date, and indicate parentage (both of us, husband only, wife only, Spouse-B only, etc.) or relationship. (i.e., sibling, niece, etc.) If you run out of space, you may enter additional information into the Family/Heir Dynamics field below.
Family Member list
FAMILY/HEIR DYNAMICS: Please describe any relationships, traits, developmental disabilities, injuries, etc. of family members, friends or others that may impact your estate plan:
ADVISORS
Personal Attorney's Name & Phone
Accountant's Name & Phone
Financial Advisor's Name & Phone
Life Insurance Agent's Name & Phone
YOUR CONCERNS

Please rate the following as to how important they are to you. (H high concern, S some concerned, L low concern, N/A no concern or not applicable)

	Spouse A	Spouse B
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of death or disability.
Providing for and protecting children, other relatives, or friends.
Providing for and protecting grandchildren.
Disinheriting a family member.
Providing for charities at the time of death.
Plan for the transfer and survival of a family business.
Avoiding or reducing your estate taxes.
Avoiding probate.
Reduce administration costs at time of your death.
Avoiding a court-supervised conservatorship in case of a disability.
Avoiding will contests or other disputes upon death.
Protecting assets from lawsuits or creditors.
Preserving the privacy of affairs in case of disability or at time of death from business competitors, predators, dishonest persons and curiosity seekers.
Plan for a child with disabilities or special needs, such as medical or learning disabilities.
Protecting children’s inheritance from the possibility of failed marriages.
Provide that your death shall not be unnecessarily prolonged by artificial means or measures.

Other Concerns (Please list):
IMPORTANT FAMILY QUESTIONS

Please check “Yes” or “No” for your answer*

	Yes	No
Are you receiving Social Security, disability, or other governmental benefits? Describe below.
Are you making payments pursuant to a divorce or property settlement order? Please furnish a copy.
Have you been widowed? If a federal estate tax return or a state death tax return was filed, please furnish a copy.
Have you ever filed federal or state gift tax returns? Please furnish copies of these returns.
Have completed previous will, trust, or estate planning? Please furnish copies of these documents.
Do you support any charitable organizations now that you wish to make provisions for at the time of your death? If so, please explain below.
Are there any other charitable organizations you wish to make provisions for at the time of your death? If so, please explain below.
Are you currently the beneficiary of anyone else’s trust? If so, please explain below.
Do any of your children have special educational, medical, or physical needs?
Do any of your children receive governmental support or benefits?
Do you provide primary or other major financial support to adult children or others?

ADDITIONAL RELEVANT INFORMATION
ESTATE INFORMATION
INSTRUCTIONS FOR COMPLETING THE CHECKLIST

This Estate Information checklist is designed to help you list your assets and net worth for estate planning and tax purposes. If you do not own property under a particular heading, just leave that section blank. Under certain headings you may own more property than can be listed on this checklist. If so, use extra sheets of paper to list your additional property. Immediately after the heading for each kind of property is a brief explanation of what property you should list under that heading. How you own your property is extremely important for purposes of properly designing and implementing your estate plan. For each property please indicate how the property is titled. When doing so, please use the following abbreviations:

Owner of Property	Use
Husband’s name alone, with no other person	H
Wife’s name alone, with no other person	W
Joint Tenancy with spouse	JTS
Joint Tenancy with someone other than a spouse, i.e., a child, parent, etc.	JTO
If in a same-sex relationship, you may also use the Spouse-A or Spouse-B identifier	i.e., S-A

REAL ESTATE PROPERTY

Please describe any interest in real estate including your family residence, vacation home, time share, vacant land, etc.
Property list
Total Market Value:
Total Loan Balance:
TANGIBLE PERSONAL EFFECTS

List separately all major personal effects such as jewelry, collections, antiques and all other valuable personal property only (indicate the type of property below and give a total sum value or use miscellaneous for less valuable items.)
Personal Effects list
Total Market Value:
MOTOR VEHICLES AND BOATS

For each motor vehicle or boat please list the following: description, how titled, market value and loan amount.
Make list here:
BANK AND CREDIT UNION ACCOUNTS

Under "Type" please indicate the owner and if the account is a checking account “CA”, savings account “SA”, certificate of deposit “CD”, or money market “MM” (indicate type below). Do not include retirement plans (i.e., IRA, 401(k)) or other pre-tax accounts here. Note: If an account is in your name for the benefit of a minor, please specify and give minor’s name.
Account list
Total Amount:
STOCKS, BONDS, INVESTMENT ACCOUNTS

Please list any and all securities you own. If held in a brokerage account, only identify the account. Do not include retirement plans (i.e., IRA, 401(k)) or other pre-tax accounts here.
Stocks, Bonds and Investment list
Total Amount:
LIFE INSURANCE POLICES AND ANNUITIES

Please enter in the following information regarding life insurance and annuities. TYPE: Term, whole life, split dollar, group life, annuity, etc. ADDITIONAL INFORMATION: Insurance company, type, face amount (death benefit), whose life is insured, who owns the policy, the current beneficiaries, who pays the premium, and who is the life insurance agent. Include only the last four digits of the policy/annuity number. Example: John Smith, New York Life, Whole Life Policy: x-4509, Primary beneficiary: Jane Smith; Contingent beneficiary: Jill Smith; Cash Value: $50,000.00; Death Value: $200,000.00
Make list here:
Total Amount:
RETIREMENT PLANS

Please enter your retirement plans. TYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K). ADDITIONAL INFORMATION: Describe the type of plan, the plan name, the current value of the plan, designated beneficiary, and any other pertinent information. Include the last four digits of the account/plan number. Example: Jane Smith, Fidelity Investments, IRA: x-4589, Primary beneficiary: John Smith; Contingent beneficiary: 50% Jack Smith and 50% Jill Smith; Value: $100,000.00
Make list here:
Total Amount:
BUSINESS INTERESTS

If you own a business, please describe it here. Please indicate whether it is a general or limited partnership, limited liability company, sole proprietorship, privately owned corporation, professional corporation, oil interest, or farm and ranch interest. ADDITIONAL INFORMATION: Give a description of the interests, which spouse owns the interest, your ownership in the interests (i.e., 100 stock shares, 35 LLC membership units), and the estimated value of the interests.
Make list here:
Total Amount:
MONEY OWED TO YOU

Please describe mortgages, loans or promissory notes payable to you. Please provide us with a copy of the note, if any.
Payable to you list
Current Balance Total:
ANTICIPATED INHERITANCE, GIFT, OR LAWSUIT JUDGMENT

Please describe any substantial gifts you have received, inheritances that you expect to receive at some time in the future, or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.
Description
Total estimated value
OTHER ASSETS

Please describe any other assets that do not fit into any listed category.
Other Assets
Total Value of other assets
SUMMARY OF VALUES

*Joint Property values enter half in Spouse-A column and half in Spouse-B column.

	Spouse A	Spouse B	Total Value
Real Property (equity value)
Tangible Personal Effects
Automobiles, Boats and RV’s
Bank and Savings Accounts
Stocks and Bonds
Life Insurance and Annuities
Retirement Plans
Business Interests
Money owed to you
Anticipated Inheritance, Etc.
Other Assets

Spouse A's total
Spouse B's total
Total Assets (all together):
Contact Information – Persons Named in Your Plan: Please provide the contact information for those you wish to identify in your estate plan. This may be family, friends or professionals you plan on naming as executors, trustees, agents under power of attorney, guardians of your children, beneficiaries of your estate, etc.
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Previous estate planning documents

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Prenuptial and postnuptial marital agreements/property agreements

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Any other relevant documentation

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OTHER ITEMS TO INCLUDE OR DISCUSS: Please list any other items you want included or want to discuss below.
Additional Information for discussion

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Married Person Intake Worksheet

INSTRUCTIONS

PERSONAL INFORMATION

CHILDREN AND/OR OTHER FAMILY MEMBERS

ADVISORS

YOUR CONCERNS

IMPORTANT FAMILY QUESTIONS

ESTATE INFORMATION

INSTRUCTIONS FOR COMPLETING THE CHECKLIST

REAL ESTATE PROPERTY

TANGIBLE PERSONAL EFFECTS

MOTOR VEHICLES AND BOATS

BANK AND CREDIT UNION ACCOUNTS

STOCKS, BONDS, INVESTMENT ACCOUNTS

LIFE INSURANCE POLICES AND ANNUITIES

RETIREMENT PLANS

BUSINESS INTERESTS

MONEY OWED TO YOU

ANTICIPATED INHERITANCE, GIFT, OR LAWSUIT JUDGMENT

OTHER ASSETS

SUMMARY OF VALUES

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