Estate Planning Summary Form - Place & Arnold, Attorneys At Law

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ESTATE PLANNING SUMMARY FORM

Printable Version

This document was last updated July 10, 2005.

Place & Arnold, Attorneys At Law

27 Pleasant Street

Fairport, NY 14450

585-425-1060 Office

585-223-3252 Fax

ESTATE PLANNING SUMMARY FORM

DATE:_____________

I. FAMILY INFORMATION (USE BACK OF PAGE FOR ADDITIONAL DATA)

A. Information about you:
Your Name______________________		Telephone Number:	___________
(Name used in business transactions, bank accounts, etc.)		Home	___________
		Work	___________
Mailing Address:
Street/P.O. Box	___________	Zip Code	___________
Town	___________	County	___________

Social Security#	___________	Occupation	___________
Date of Birth	______________________
Date & Place of Marriage	______________________

B. Information about your spouse

Name	___________	Occupation	___________
Social Security#	______________________
Date of Birth	______________________

C. Information about your children:

Name	Address	Date of Birth (If under 18)
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________
D. Information about your grandchildren:

Name	Address	Date of Birth (If under 18)
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________

E. If you have no spouse, children or grandchildren, please list your nearest relatives and their addresses: (INDICATE RELATIONSHIP)

Name	Address	Relationship
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________
___________	_____________________________	___________

F. If minor children, please provide name and address of Proposed Guardian (s) and Alternate guardian (s):

1st:	_______________________________________________________
	_______________________________________________________
2nd:	_______________________________________________________
	_______________________________________________________

G. Proposed Executor (s) name and address:

1st:	_______________________________________________________
	_______________________________________________________
2nd:	_______________________________________________________
	_______________________________________________________

H. Proposed Trustee (s) and address:

1st:	_______________________________________________________
	_______________________________________________________
2nd:	_______________________________________________________
	_______________________________________________________

II. ASSET INVENTORY (USE BACK OF PAGE FOR ADDITIONAL ASSETS)
		APPROXIMATE VALUES
A. Bank Accounts:		Name of Bank	$

Your Name	______________________	_________	_________
Spouse’s Name	______________________	_________	_________
Joint Name	______________________	_________	_________

B. Life Insurance (Please include Group Insurance)

Company	Face Amount	Beneficiary
1)___________	______________________	___________
2)___________	______________________	___________
3)___________	______________________	___________

C. Stock:

Number of Shares	Company	Value

1)___________	______________________	$___________
2)___________	______________________	$___________
3)___________	______________________	$___________
4)___________	______________________	$___________
5)___________	______________________	$___________

D. Real Estate residence and investment property (Indicate amount of mortgage, if any in Section 111(C))

Location:	Value

1)_________________________________	$___________
2)_________________________________	$___________

E. Notes owed to you and Bonds (Include U.S. Bonds)

Name of Marker of Issuer:	Face amount of notes or bonds

1)_________________________________	$___________
2)_________________________________	$___________
3)_________________________________	$___________

F. Personal Property

1) Contents of residence	$___________
2) Coin, stamp or similar collection	$___________
3) Paintings, Silver	$___________
4) Jewelry	$___________
5) Furs	$___________
6) Car (s)	$___________

G. Business Interests

Name & Address of Business

Yours _____________________________________________________________
__________________________________________________________________
Spouse ____________________________________________________________
__________________________________________________________________

Value of interest $________ $________	$________ ________ % of Total

Names (s) of other Partners or shareholders:
__________________________________________________________________
__________________________________________________________________

Description of any Buy-Sell, stock redemption, or other agreements affecting value of interest (describe)

Value/Per Agreement
__________________________________________________________________
__________________________________________________________________

H. Rights under Employee Benefit Plan (Pension, Profit- Sharing or Stock Bonus Plan)
__________________________________________________________________
__________________________________________________________________
Name of Beneficiary: _________________________________________________

I. Rights under existing Estates & Trusts, includes Powers of Appointment
__________________________________________________________________
__________________________________________________________________

J. Expected Inheritance (s) ________________________________________

GROSS ESTATE - Yours ____________________________________________
GROSS ESTATE - Spouse ____________________________________________
TOTAL	Joint Property
	1) With Spouse	$___________
	2) With others	$___________

III. LIABILITIES

A. Accounts Payable-Credits	$___________	$___________
B. Long Term Debt	$___________	$___________
C. Mortgage (s)	$___________	$___________

Total Liabilities	$___________	$___________

NET ESTATE; BEFORE EXPENSES, FEES AND ESTATE TAXES	$___________	$___________

IV. LOCATION OF SAFE DEPOSIT BOX (any)
__________________________________________________________________
__________________________________________________________________

V. PRIOR MARRIAGES (ANY) Provisions for former spouse under Separation Agreement or Decree of Divorce.



VI. WILL PROVISIONS List proposed Legatees of items of tangible personal property or cash, devisees of real estate, indicating item, amount or percentage of estate, as to real property, state location and nature of real property, e.g., house, cottage, etc.



VII. ANY PRIOR WILLS? WHERE LOCATED


VIII. POWER OF ATTORNEY


XI. HEALTHCARE PROXY


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