Estate Planning Worksheet Estate Planning Worksheet "*" indicates required fields Step 1 of 15 - General Information 0% Welcome Welcome to the Sandin Law digital Estate Planning Worksheet. Completing this worksheet will assist us in designing an estate plan that meets your goals. It is very important that you provide all requested information that is applicable to you with as much detail as possible. We use this information to provide recommendations to you in your estate planning. All information provided to us is confidential. Please complete this worksheet at least three (3) business days prior to your appointment. This will allow us adequate time to review your information so that we can have a productive conversation.General Information Are you married?* Yes No Date of Marriage Month Day Year Do you have a pre-marital agreement?* Yes No Type of Plan* This estate plan is for me only This estate plan is for me and my spouse (joint) My Name* First Middle Initial Last Also Known As First Middle Initial Last My Date of Birth* Month Day Year My Spouse's Name* First Middle Initial Last Whether this plan is single or joint, please enter your spouse's name.Also Known As First Middle Initial Last Spouse's Date of Birth Month Day Year Home Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country of Citizenship Spouse's Home Address (if different) Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country of Citizenship Home PhoneMobile PhoneEmail* Spouse's Home PhoneSpouse's Mobile PhoneSpouse's Email My Employment Status Employed Unemployed Retired My Occupation My Employer/Business Name My Work PhoneMy Work Address Address Line 1 Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's Employment Status Employed Unemployed Retired Spouse's Occupation Spouse's Employer/Business Name Spouse's Work PhoneSpouse's Work Address Address Line 1 Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Methods of Communication (mark all that apply) Home Address Home Phone Mobile Phone Business Phone Email Family Information Were you previously married?* Yes No How did your previous marriage end? Due to Death of Spouse Due to Divorce Spouse's Date of Death* Month Day Year Do you have any testamentary obligations under a divorce decree? If so, please describe.*Was your spouse previously married?* Yes No How did your spouse's previous marriage end? Due to Death of Spouse Due to Divorce Does your spouse have any testamentary obligations under a divorce decree? If so, please describe.*Parents Parent's Name Relationship Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Children Child's Name Date of Birth Gender Child Of Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Grandchildren Grandchild's Name Parent Date of Birth Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. My Siblings Sibling's Name Relationship Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. My Spouse's Siblings Sibling's Name Relationship Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Goals and Concerns GoalsPlease describe your primary goal regarding your visit to our office:*Please describe your secondary goals:ConcernsPlease indicate whether any of the following are a concern: Naming a guardian for minor children Disinheriting a family member Providing for charities at the time of your death Planning for the transfer and survival of a family business Avoiding or reducing your estate taxes Avoiding probate / reducing administration costs at the time of your death Potential creditor issues Avoiding will contests or other disputes upon your death Preserving the privacy of affairs Planning for a child or grandchild with disabilities or special needs Protecting children’s inheritance from failed marriages, bankruptcy or creditors Avoiding a conservatorship (“living probate”) in case of disability or incapacity Providing for wishes concerning medical decisions upon incapacity Other Concerns Describe other concerns here: Additional Information Current Estate Planning Do you currently have any of the following estate planning documents: If so, please provide a copy with this worksheet prior to your meeting.Will* Yes No I Don't Know Power of Attorney* Yes No I Don't Know Trust* Yes No I Don't Know Health Care Directive* Yes No I Don't Know Do you currently possess a power of appointment?* Yes No I Don't Know Financial RelationshipsPlease specify all of your financial relationships, such as your CPA, financial advisor, banker, etc. Financial Contact's Name Type Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. MiscellaneousHave you ever lived in or acquired property in a community property state?*(Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin) Yes No I Don't Know Have you ever made a gift to anyone which required filing a gift tax return?* Yes No I Don't Know Do you anticipate your estate growing substantially in the near future?* Yes No I Don't Know Health Care Directive Information A health care directive allows you to appoint a person or persons (health care agent) to make health care decisions for you in the event you are unable to make them for yourself. It can also include instructions to your agent regarding your health care wishes. Your health care agent should be someone you trust and who would follow your wishes even if they conflict with their own personal wishes or beliefs.Who would you like to appoint as your health care agent(s)?*Please include relation, name, address, and phone number if not already provided in the family information above.Who would you like to appoint as your successor agent(s)?*Please include relation, name, address, and phone number if not already provided in the family information above.If you have named multiple people, do you want to require them to act jointly?Are you an organ donor?* Yes No I Don't Know Is your spouse an organ donor?* Yes No I Don't Know Would you like to include instructions regarding the disposition of your remains? If so, please explain.*Are you interested in a Catholic Health Care Directive (HCD)?*please select...YesNoI'm Not SurePower of Attorney Information A power of attorney grants a person (attorney-in-fact) the power to handle your financial matters. Your attorney-in-fact should be someone you trust and who is financially knowledgeable or capable of understanding and handling your financial affairs.Who would you like to appoint as your attorney-in-fact?*This individual essentially makes financial decisions for you in the event you cannot make them. Please include relation, name, address, and phone number if not already provided in the family information above.Who would you like to appoint as your successor attorney-in-fact?*Please include relation, name, address, and phone number if not already provided in the family information above.Personal Representative Under Last Will & Testament A personal representative is a person who, under the supervision of a probate court, settles a decedent's financial affairs and distributes the decedent’s property according to the terms of the decedent’s will.Who would you like to appoint as your Personal Representative?*Please include relation and nameWho would you like to appoint as your successor personal representative?(include relation and name)Guardians Who would you like to appoint as your child(ren)’s guardian?*(include relation and name)Who would you like to appoint as your child(ren)’s successor guardian?*(include relation and name) Financial Information | Schedule A - Cash and Notes Cash Accounts Name of Institution Estimated Balance Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Subtotal Cash AccountsDigital Assets Digital Asset Type Balance or Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Subtotal Digital AssetsLoans or Notes Receivable (money owed to you) Obligor Rate Due Date Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Subtotal Loans and NotesGrand TotalPlease list any government benefits you receive (if any):(Social Security, SSI, SSDI, Medicare, Medicaid, Food Stamps, etc.) Financial Information | Schedule B - Real Estate For valuation purposes, use your best estimate of current total values, without regard to any mortgages that may be outstanding. Mortgage information should be described on Schedule I.Real Estate Ownership Type Address or Description County & State Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. TotalInsurance PoliciesDo you have a title insurance policy on your real estate?* Yes No When did you acquire it? What company is the policy through? Do you have a home owners’ insurance policy on your real estate?* Yes No What company is the policy through? Financial Information | Schedule C - Securities Held by You Securities Security Type Name of Security Payable on Death to: Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Total Financial Information | Schedule D - Closely Held Business Interests Include all limited liability companies, corporations, and partnershipsClosely Held Business Interests Name of Business Type of Entity Estimated Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Please supply copies of partnership agreements, buy-sell agreements, related insurance arrangements or any other documents relevant to the business listed aboveClosely Held Business Documents (please upload) Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB. Closely Held Business Interest TotalComments Financial Information | Schedule E - Life Insurance Life Insurance Policies Company Policy Number Death Benefit Amount Cash Value Primary Beneficiaries Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. When describing type of policy, please indicate whether term, variable life, universal life, or whole lifeLife Insurance Policies Total Financial Information | Schedule F - Annuities Annuities Company Contract No. Current Value Cost Basis Annuitant Primary & Contingent Beneficiaries Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Annuities Total Financial Information | Schedule G - Qualified Retirement Plans & IRAs Retirement Assets Type Name of Custodian or Plan Sponsor Account Number Primary Beneficiaries Estimated Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Retirement Assets Total Financial Information | Schedule H - Tangible Personal Property Tangible Personal Property Item Item Details Estimated Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Tangible Personal Property TotalDescribe collections, antiques, guns, heirlooms, etc. that require special estate plan considerations, and give any other pertinent comments: Schedule I - Liabilities Mortgages (describe/identify property) Mortgages (describe/identify property) Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Mortgages TotalLoans/Notes (identify creditor) Loans/Notes (identify creditor) Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Loans/Notes TotalOther Liabilities (describe) Other Liabilities (describe) Value Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Other Liabilities Total Financial Summary AssetsCash & Notes - (Schedule A)Real Estate - (Schedule B)Securities - (Schedule C)Close-held Business Interests - (Schedule D)Life Insurance (Death Benefit) - (Schedule E)Annuities - (Schedule F)Qualified Retirement Plans & IRAs - (Schedule G)Tangible Personal Property - (Schedule H)Assets TotalLiabilitiesMortgages - (Schedule I)Loans/Notes - (Schedule I)Other Liabilities - (Schedule I)Liabilities Total Assets Minus LiabilitiesNet Worth
