gravity Estate Planning Questionnaire

ESTATE PLANNING INFORMATION PACKET

Date

ment for the initial consultation is expected at the conclusion of your conference with your attorney, unless other arrangements have been made.

Personal Profile

Client Full name

Other name

Home Address

Address 2

City

State

Zip Code

County Of Residence

Home Phone

Work Phone

Cell Phone

Email Address

Occupation

Employer

Social Security Number

Date Of Birth

Period of Residence in California

Are you a U.S. Citizen? Circle One:

Yes No

Spouse

Full Names

Other name

Home Address

Address 2

City

State

Zip Code

County Of Residence

Home Phone Number

Work Phone

Cell Phone

Email Address

Occupation

Employer

Social Security Number

Date Of Birth

Period of Residence in California

Are you a U.S. Citizen? Circle One:

Yes No

Any Agreements

Is there a prenuptial agreement or marital agreement?

Yes No

Marriage Information

Date of Marriage

Place

Marital Relationships

Prior marriages of Client/Spouse

Has Client or Spouse been married before?

Yes No

Number of prior marriage for Client

Spouse

If yes, give the following information for each former marriage:

Name of former spouse

Date of marriage

Was marriage ended by death or divorce

Date the divorce was final (or date of death)?

Children

Child(1)

Yes No

Name

Child of

Client/Spouse Client Spouse

Address

Street Address

City

State

Zip Code

Phone

BirthDate

Child(2)

Yes No

Name

Child of

Client/Spouse Client Spouse

Address

Street Address

City

State

Zip Code

Phone

BirthDate

Child(3)

Yes No

Name

Child of

Client/Spouse Client Spouse

Address

Street Address

City

State

Zip Code

Phone

BirthDate

Child(4)

Yes No

Name

Child of

Client/Spouse Client Spouse

Address

Street Address

City

State

Zip Code

Phone

BirthDate

Child(5)

Yes No

Name

Child of

Client/Spouse Client Spouse

Address

Street Address

City

State

Zip Code

Phone

BirthDate

Are there any deceased children?

Yes No

Did they leave any surviving children?

Yes No

Names and ages of any surviving children of the deceased children

If Your Children Are Minors

Name, address, and phone number of person to serve as Guardian

Backup

Financial Profile

Income	Husband	Wife	Joint
Monthly Earned Income
Monthly Social Security Income
Monthly Pension Income
Other Monthly Income

List all Real Property (i.e., land or homes) owned by you and how title is held:

- Please provide “Grant Deeds” for all California real property.

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Cash (checking accounts, savings accounts, CDs, or money markets)

Checking

FMV:

Owe:

Savings

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Automobiles, Boats and RV’s

FMV:

Owe:

FMV:

Owe:

Securities (common stock, preferred stock, corporate bonds, mutual funds)

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Retirement or other employee benefits including 401(k), IRA or Keogh accounts, include the names of the beneficiaries of these benefits.

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Life Insurance which you own

Face value

Cash value

Type of Policy (term, whole life)

Name and address of each insurance company and policy number.

Business Interests

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Are you the holder of any promissory notes?

Yes No

If yes, for each, list name of payor , the name of the payee and the current outstanding balance

Are you the beneficiary of any will or trust?

Yes No

Name of the trust

Name of the trustee

Value of trust principal and income

Any general power of appointments in another persons will or trust?

Yes No

List your tangible personal property of significant value

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Anticipated Gifts or Lawsuit Judgment (Please describe)

Total Gross:

Other Assets

FMV:

Owe:

FMV:

Owe:

Total Gross:

Total Net:

Summary of Values

Real Property

Cash

Automobiles

Securities

Retirement

Life Insurance

Business Interests

Notes

Inheritance

Power of Appointments

Personal Property

Gifts of Judgments

Other Assets

TOTAL

Total Gross Estate:

Total Net Estate:

Advisors

	Name	Telephone
Personal Attorney
Accountant
Financial Advisor
Life Insurance Agent

Are you happy with your current advisors?

Yes No

Do you need a referral for any of the above?

Yes No

Is there an advisor that you believe I should get to know:

Successor Trustees and Executors: After your death, who do you want carrying out your instructions, for distribution of your estate and, if desired, for management of the property for your beneficiaries. The primary criteria for trustee is trustworthiness. This person should also be good with the management of time and money

First Successor Trustee (or Executor):

Name

Address

Phone Number

Second Successor Trustee (or Executor):

Name

Address

Phone Number

Third Successor Trustee (or Executor)(Optional):

Name

Address

Phone Number

Executors

Same as Successor Trustees?

Yes No

Other

Disposition of Your Estate (Who do you want to be your Beneficiaries?)

How do you wish the remainder of your estate to be distributed?

If you have children:

Should your property be divided equally amongst your children?

Yes No

If No, then who or how?

Should the trust property be held in trust until a later age?

Yes No

Until what age?

Should a deceased child’s share go to their children (your grandchildren)?

Yes No

If No, then who or how?

Should the trust property be held in trust until a later age?

Yes No

Until what age?

Anything else

If you don’t have children:

Who would you like to receive your estate and how much of it should they receive?

Is there anyone you wish to specifically disinherit? If so, please indicate below:

Please indicate any specific gifts of real or personal property that you wish to leave to a specific person:

Other notes:

Powers of Attorney for Legal and Financial Affairs: If you were unable to make legal or financial decisions for yourself, who would you want to make those decisions for you?

Client:

Name

Address

Telephone number of person you wish to serve as your DPA Finances

Spouse is the first Agent?

Yes No

If No, then First

Second

Third

Spouse:

Name

Address

Telephone number of person you wish to serve as your DPA Finances

Spouse is the first Agent?

Yes No

If No, then First

Second

Third

Advanced Health Care Directive: If you were unable to make health care decisions for yourself, who would you want to make those decisions for you?

Client:

Name

Address

Telephone number of person you wish to serve as your DPA Health

Spouse is the first Agent?

Yes No

If No, then First

Second

Third

Spouse:

Name

Address

Telephone number of person you wish to serve as your DPA Health

Spouse is the first Agent?

Yes No

If No, then First

Second

Third

Other Items to Include or Discuss: Your estate plan should address all your hopes, fears and wishes. Please list any other items you would like addressed or covered.

Is there anything unique about your situation that the attorney should know about?

Anything else?

There are time requirements and disclosure requirements that need to be complied with in order to have a valid premarital agreement. Please return this questionnaire immediately.

You cannot validly waive spousal support unless both sides are represented by an attorney. Just because both sides are represented does not mean that a court cannot set aside an invalid waiver.

Spousal support waivers may still not apply if a court finds them unconscionable at the time of the dissolution (or at the time one party tries to enforce the waiver).

Premarital agreement document review and signing appointments are typically available Monday through Friday starting at 8:30 a.m. Afternoon appointments must usually commence by 4:30 p.m. Exceptions are made for emergencies and special circumstances.

Thank you for allowing us to be of service with your family law needs!

ESTATE PLANNING INFORMATION PACKET

Prior marriages of Client/Spouse

If yes, give the following information for each former marriage:

List all Real Property (i.e., land or homes) owned by you and how title is held:

- Please provide “Grant Deeds” for all California real property.

Cash (checking accounts, savings accounts, CDs, or money markets)

Automobiles, Boats and RV’s

Securities (common stock, preferred stock, corporate bonds, mutual funds)

Retirement or other employee benefits including 401(k), IRA or Keogh accounts, include the names of the beneficiaries of these benefits.

Special Instructions