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Estate Planning Questionnaire

* = required

First name*

Middle Name(s)

Last name*

Birthday*

Month

Day

Year

Phone*

Email*

Address*

Do you have an existing will or trust?*

Yes

If so, upload it here:

If you are legally married, what is your spouse's name?

Spouse's Birthday

Month

Day

Year

If you have any children, list their names and birthdays:

Assets (list all applicable; DO NOT include confidential information here):

Real Estate

Retirement Accounts

Checking Accounts

Life Insurance

Savings Accounts

Vehicles

Investment Accounts

Items of Great Value (jewelry, artwork, etc.)

Administration

Name a Personal Representative (person in charge of administering your estate:

First Executor*

Second Executor

Third Executor

Name a Trustee (person in charge of administering trust; typically the same as personal representative):

First Trustee*

Second Trustee

Third Trustee

Distribution of Assets

List all specific gifts you want to make:

The remaining property after specific gifts is called the remainder. The remainder is distributed by percentage. List how you want the remainder distributed:*

List any specific conditions you want to place on any distributions:

Special Requests

Power of Attorney

Give Agent immediate authority

Name an Agent (typically the same as personal representative/trustee):*

Agent's Phone*

Agent's Email*

Agent's Address*

Name an Alternate Agent

Alternate's Phone

Alternate's Email

Alternate's Address

Which powers do you want your Agent to have? Check all that apply.*

Real Property Transactions

Tangible Personal Property Transactions

Stock and Bond Transactions

Commodity and Option Transactions

Banking and Financial Institution Transactions

Insurance and Annuity Transactions

Estate, Trust, and Other Beneficiary Transactions

Claims and Litigation

Personal and Family Maintenance

Benefits From Social Security, Medicare, Medicaid, or Other Governmental Programs, or Civil or Military Service

Retirement Plan Transactions

Tax Matters

Printable Version

Jorgensen, esq.

510-295-9641

ryan@jorgensenesq.com

3240 Telegraph Ave Oakland, CA 94609 *Mailing Address Only

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