Estate Planning

About Our Firm Areas of Practice News Letters / Updates Contact Us Links

ESTATE PLANNING QUESTIONNAIRE

Print this form and mail, fax, or bring to:
Keith Hyche
51 High St.
Newton, NJ 07860
Fax: (973) 300-0162

This questionnaire will help highlight some of the basic information necessary to begin your estate planning process. The information is necessary for reaching several estate planning decisions. The more details you can provide the better. If you need more space please attach a separate sheet. All information will be kept in the strictest confidence.

PLEASE NOTE, THIS QUESTIONNAIRE IS NOT INTENDED TO REPLACE PERSONAL CONSULTATIONS WITH AN ATTORNEY. IT IS ONLY A BASIC STARTING POINT FOR AN ESTATE PLAN

Name (including any maiden name, aliases, or a.k.a.'s): ________________________________________

How would you like your name to appear on the documents I prepare?
________________________________________________________________
Social Security Number:__________________ Date of Birth:_________________
Mailing Address:__________________________________________________
Township:_______________________________ County:__________________
Home Telephone:________________ Work Telephone:_____________________
Spouseís Name:____________________________________________________
Spouseís Social Security Number:_______________________________________
Spouseís Date of Birth:_________________________
Your Citizenship:______________________________
Spouseís Citizenship:___________________________
CHILDREN (List ALL of your biological and adopted children):
Childrenís Names: Date of Birth

_________________________________________  ____________________

__________________________________________  ____________________

__________________________________________  ____________________

__________________________________________  ____________________

Do you have a prior will? If so please attach.   YES ____   NO ____
Have you or your spouse had a prior marriage?   YES ____   NO ____
Did same terminate as a result of death?    YES ____    NO ____
Do any of your children have any special medical or financial needs? If so, please explain on a
separate sheet.   YES ____   NO ____
Do you have any adopted children?   YES ____   NO ____
Do you have any step children?   YES ____   NO ____
Do you own your own home?   YES ____   NO ____
Do your assets at present exceed $675,000 in value?   YES ____   NO ____
Are you expecting any inheritances or other income in the future that may cause your
estate to exceed $675,000?   YES ____  NO ____

Do you own any businesses, either by yourself or with anyone else? If so, briefly describe the nature of each business and the type of entity it is (i.e. proprietorship, partnership, or corporation).

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

List location of any out of state real estate you own:
___________________________________________________________________

___________________________________________________________________

Do you wish to leave anything to charity?   YES ____   NO ____
If so, to whom and for what purpose and what amount?__________________________

Do you have any bequests of specific items you would like to make?
_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Your choice for Executor (most married people will choose their spouse as Executor):

Name:_________________________ Relationship________________________

Address:_________________________________________________________

If the person you choose as Executor predeceases you, or if he/she is unable to serve, whom do you choose as an alternate Executor? Name:____________________________  Relationship:_____________________

Address:_________________________________________________________________

Do you want your estate to be distributed upon your death to your spouse and, if your spouse is not living, to your children?   YES ____    NO ____

If not, how do you want your estate distributed? ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

If you have children, list the name of the desired guardian (recognizing that they donít have to serve if they donít wish to):

Name:___________________________  Relationship___________________________

Address:_______________________________________________________________

Alternateís Name:________________________________________________________

Relationship:________________________

Address:________________________________________________________________

Do you want your childrenís share of your estate to go into a trust?   YES ____   NO ____

At what age would you want your children to receive the proceeds?

Age 21?   YES ____   NO ____

                        -OR-

25% at age 22 or graduation from college; 25% at age 25; 25% at age 27; 25% at age 30 with interest paid annually to the children between the ages of 22 and 30?   YES ____    NO ____

                       -OR-

Other:____________________________________________________________

_________________________________________________________________

_________________________________________________________________

Whom do you wish to serve as Trustee of your children's Trust (recognizing that they donít have to serve if they donít wish to)

Name:___________________________ Relationship________________________

Address:___________________________________________________________

Alternateís Name:____________________________________________________

Relationship:___________________________________

Address:___________________________________________________________

Your estimated net worth, (including amount of any life insurance payable to others upon your death):
________________________________________________________

Spouseís estimated net worth:_________________________________


If your estate exceeds $675,000.00 at present or will exceed $675,000.00 (including life insurance*, pensions and retirement benefits) upon the death of you or your spouse, whichever is later, list your assets and how they are owned below. If your estate will not exceed $675,000.00 please skip to the next section. Please note: If your estate exceeds $675,000.00 you will need additional estate planning to minimize or possibly eliminate estate taxes.

Current Market Value  -  How Owned H/W Joint  -   Current Equity

Home:
_________________   _________________   __________________
Savings: 
_________________   _________________   __________________
Checking: 
_________________   _________________   __________________
IRA- Husband: 
_________________   _________________   __________________
IRA- Wife: 
_________________   _________________   __________________
Life Insurance- Husband: 
_________________   _________________   __________________
Life Insurance- Wife: 
_________________   _________________   __________________
Stocks: 
_________________   _________________   __________________
Investments: 
_________________   _________________   __________________
Pension: 
_________________   _________________   __________________

(Add additional pages as needed or attach financial statement.)

POWER OF ATTORNEY INFORMATION

Do you want to arrange a Power of Attorney** authorizing your spouse or someone else you trust to sign documents and conduct financial transactions on your behalf if you cannot do so yourself due to a disability?   YES_____  NO_____ 
If YES, complete the following information for your Power of Attorney, otherwise, skip to the next section:

Name ______________________________________________________

Relationship _________________________________________________

Address: ____________________________________________________

Alternate Name: _______________________________________________

Relationship __________________________________________________

Address: ____________________________________________________


LIVING WILL INFORMATION
Do you want a Living Will, ***  which gives another person the authority to disconnect any extraordinary life-support measures if you lack the mental or physical ability to make the decision yourself?   YES_____  NO_____

If YES, please answer the following:
Whom do you authorize to sign the medical treatment or withdrawal of treatment consent form?
Name: ______________________________________________________

Relationship __________________________________________________

Address: _____________________________________________________

Alternate:_________________________ Relationship:__________________

Address:_______________________________________________________


Do you consider intravenous feeding a life support measure you would wish to be discontinued?     YES_____  NO_____

Do you wish to be an organ donor upon your death? YES____   NO____

Do you have any matters of specific concern to you that you want addressed in your Living Will? YES_____  NO_____
(If you answered YES, please attach a separate sheet of paper explaining your concerns.)


TODAYíS DATE: ________________________________

Your Signature: __________________________________

* Life Insurance proceeds normally pass to a named beneficiary income tax and estate tax free. We will discuss this in greater detail at your appointment.

** Power of Attorney authorizes your spouse or someone else you trust to sign documents and conduct financial transactions on your behalf if you cannot do so your self due to disability. 

  *** Living Will which gives another person the authority to disconnect any extraordinary life-support measures if you lack the mental or physical ability to make the decision yourself.

Back To The Top

This site copyrighted 2010 by Triton Web Design All rights reserved.