Please fill out this questionnaire as completely as possible. Estimates are fine. If you don’t know an answer, or a question is not applicable, please note such. If an answer differs for H and W, specify such. If you have questions about any current documents, send COPIES of them (e.g. wills, trusts, powers of attorney) with the completed questionnaire. Attach supplemental schedules or additional information if needed. Please fax (760-295-6821) or mail (1653 Magnolia Circle, Vista, CA 92081-4550) (mail if total “package” is more than 10 pages) the completed questionnaire to Severance & Associates. We will get back to you with a suggested estate plan, needed documents, and an estimated fee quote.
H = HUSBAND (or single person) W = WIFE
**********************Full Name***********Social Sec #***********Birthdate********US
Citizen?
H
W
Occupation/Employer:
H
W
Address:
City, State, Zip:
Phone, Fax, Email:
Residents of California since:
Date and Place of marriage:
Prior marriages by either spouse?____ Divorce?____ Death?____ Specify with
dates:
Living children of this marriage:
Name***********Birthdate*******Address/City/State*******Married?***# of children
Deceased children of this marriage: Specify
Living children of prior marriages: Specify
Deceased children of prior marriages: Specify
Any grandchildren from the above three categories? Specify
List any brother, sisters, parents, or others, exclusive of children, dependent on you for support:
If you have minor children, specify your first and second choices for guardians of the person and property after the surviving spouse: Include Name & Address.
List your first and second choices for executors of the wills and trustees of the trust after the surviving spouse: Include Name & Address.
List your first and second choices for agents for your Advance Health Care Directives after the surviving spouse: Include Name & Address & Home/Work Phone Numbers.
Do you currently have a Will?____Trust?____Advance Health Care Directive or Durable Power of Atty?____Please provide copies
Do you anticipate any substantial gifts or inheritances? Specify
Specify any personal (other than to children) or charitable bequests in your will or trust:
Specify any funeral or burial or cremation requests:
What is your basic plan of disposition of assets upon death?
ESTIMATED ASSETS
AND LIABILITIES: (rough estimates are fine)
************************Description************Market Value***Original
Cost***How Title Held
CASH
SECURITIES
PERSONAL
PROPERTY
REAL ESTATE
BUSINESSES
RETIREMENT
PLANS
LIFE INS
OTHER
DEBTS OWED
For Living Trusts, please provide clear COPIES of all deeds to real estate that you own.
Anything else you want to add that hasn't been addressed?