ESTATE PLANNING QUESTIONNAIRE (Copyright 1998)

Name __________________________

Spouse's name____________________

Address __________________________________________

Names/ages of children__________________________________

Own ____ Rent ____

Home equity (market value less debt) __________________

Other real estate: description/value/equity _______________________

Life insurance: name of insurer ________________________

Policy no. _________________ term ____ whole life ___

Beneficiar(ies) _______________________________________

Other assets (description and value):

Automobiles ___________________________

Bank accounts __________________________

Stocks________________________________

Bonds ________________________________

Jewelry _______________________________

Other _________________________________

Name/relation of executor __________________

Name/relation of guardian __________________

Name/relation of trustee ____________________

I want a ___ simple will ___will with trust ___living will

other ____________________________________