Estate Planning Questionnaire

About You

Your Information

Full legal name *

Other names you have used (maiden name, etc.)

Home address *

Daytime phone *

Evening / mobile phone

Email address

If provided, we will email you a confirmation.

Date of birth

Name & relationship of anyone who will accompany you to your appointment

Citizenship & Residence

Are you a U.S. citizen?

Yes No

Country of citizenship

Do you spend significant time in another state or country (for work, vacation, or family)?

No Yes

Please describe: which state or country, how much time you spend there, where you vote, register your car, and file tax returns, and any property you own there

Language & Accessibility

Primary language

Will you need an interpreter?

No Yes

Do any of the following apply to you? (check all that apply)

Limited vision Limited hearing Limited speech Difficulty reading English

Any other physical, mental, or memory conditions we should know about (optional)

Marital Status

Current marital status *

Spouse's full name

Spouse's phone

Spouse's address (if different from yours)

Are you and your spouse living apart?

No Yes

Briefly, why?

Late spouse's name, and date & place of death

Have you been married before?

No Yes

How many times?

Ex-spouse's name

Ex-spouse's last known address

Date & place of divorce (state and court), and name of the attorney who handled it, if known

Do you have a partner who is the equivalent of a spouse?

No Yes

Partner's name

Partner's address

Your Family

Parents

Mother's name

Is your mother living?

Living Deceased

Mother's address & phone

Father's name

Is your father living?

Living Deceased

Father's address & phone

Siblings

Add each of your brothers and sisters, including half- and step-siblings. Skip if none.

Children

Do you have any children?

No Yes

Include all children — biological, adopted, and step-children, from this or any prior relationship. Do not enter children's Social Security numbers.

Anything else about your children we should know (adoptions, foster care, disabilities, a child who has passed away, grandchildren)

Are any of your children under 18?

No Yes

Guardians & Trustees for Minor Children

A guardian raises your minor children if you cannot. A trustee manages money you leave for them. They can be the same person or different people.

The Other Parent

Is the other parent of your minor children living?

Living Deceased

Other parent's name and date of death

Describe each child's relationship with the other parent, and the other parent's ability to care for the children. If you are naming someone else as guardian, briefly explain why.

Has the other parent ever been convicted of a crime?

No Yes Not sure

Proposed Guardian

Primary guardian — name

Relationship to you

Address & phone

Occupation / source of income

Alternate guardian — name

Relationship to you

Address & phone

Occupation / source of income

Has any proposed guardian ever been convicted of a crime?

No Yes Not sure

Proposed Trustee

Primary trustee — name

Relationship to you

Address & phone

Occupation / source of income

Alternate trustee — name

Relationship to you

Address & phone

Occupation / source of income

Has any proposed trustee ever been convicted of a crime?

No Yes Not sure

If you want different guardians or trustees for different children, explain here

Income & Assets

Approximate amounts are fine. Do not enter account numbers — the bank or company name is enough for now.

Income

Employment — employer's name & address, and your approximate income

Social Security benefits (type & monthly amount)

Public assistance (type & amount)

Pension & Retirement

Do you receive, or expect to receive, a pension or retirement benefit (401(k), IRA, etc.)?

No Yes

Describe: who provides it, current or expected amount

Does it provide death benefits?

No Yes Not sure

Named beneficiary, if any

Company or plan contact information (name, address, phone)

Company & Union Benefits

Company benefits (health, pension, profit-sharing, life insurance through work) — company name, type of benefit, and contact office

Are you a union member with benefits?

No Yes

Union name & local number

Office to contact (address & phone)

Named beneficiary & relationship, if any

Your Home

Do you rent or own your home?

Rent Own

Type of property

Approximate value

Exact name(s) on the deed (or co-op stock/lease)

Is there a mortgage?

No Yes

Lender & approximate balance

Is the apartment rent-stabilized or rent-controlled?

No Yes Not sure

Exact name(s) on the lease

Other Real Estate

Do you own or have an interest in any other real estate (here or abroad)?

No Yes

Do you stand to inherit an interest in any real estate?

No Yes

Describe the property and the circumstances

Bank Accounts

Savings, checking, CDs, and money market accounts. Do not enter account numbers.

Life Insurance

Do you have life insurance?

No Yes

Investments

Brokerage accounts — firm name, branch or representative, and whether anyone else has an interest in the account

Stocks & bonds held outside a brokerage account — issuer, number of shares, approximate value

Debts & Other

Your principal debts, in total (approximate)

Is anyone holding money owed to you, or are you part of a lawsuit that may pay you money?

No Yes

Please describe

While married, have you or your spouse ever lived in a community-property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, Wisconsin) or outside the United States?

No Yes Not sure

Which state(s) or country(ies), and during what years?

Your Will — Who Gets What

Existing Documents

Do you have a previous will?

No Yes

Have you previously signed a durable power of attorney?

No Yes

Personal Belongings

Who should receive your tangible personal property (furniture, jewelry, personal effects)?

Main beneficiary — name

Relationship & phone

Alternate beneficiary (if the first passes away before you) — name, relationship & phone

Specific Gifts

Specific items or dollar amounts you want to leave to particular people or charities (e.g. "$10,000 to my niece", "my ring to my daughter"). Skip if none.

Everything Else (Residuary Estate)

After specific gifts, who should receive the rest of your estate? If more than one person, include the share for each (e.g. "my three children equally").

Main beneficiary(ies) — names, relationships & shares

Alternate beneficiary(ies) — if the above pass away before you

Is there any close family member you specifically want to exclude from your will? Name(s)

Do you have close relatives not already listed in this form — for example, children of a brother or sister who has passed away? The court requires us to identify your nearest relatives, even if they receive nothing.

Executor & Final Arrangements

Executor

Your executor carries out the instructions in your will.

Executor — name

Relationship & phone

Address

Alternate executor — name (ideally a New York State resident)

Relationship & phone

Address

Should your executor be required to post a bond? (A bond is insurance the estate pays for; most wills waive it when the executor is a trusted person.)

No — waive it Yes Prefer to discuss

Would you like two or more people to serve together as co-executors?

No — one at a time Yes

Must the co-executors act together, or may each act separately?

Together Separately Prefer to discuss

Please name the co-executors in the "Anything else" box on the last step.

Funeral & Burial Wishes

Burial or cremation?

Burial Cremation Undecided / prefer to discuss

Do you have prepaid funeral plans or a cemetery plot?

No Yes

Funeral home / cemetery name, address & phone

Any other wishes for your funeral or the disposition of your remains

Advance Directives

These documents let people you trust act for you if you become unable to act for yourself. For any question, "prefer to discuss" is a perfectly good answer.

1. Power of Attorney

Lets someone you trust handle your finances (banking, bills, property) if you cannot.

Would you like a power of attorney?

Yes No Prefer to discuss

Agent — name

Relationship & phone

Address

Alternate agent — name

Relationship & phone

Address

2. Health Care Proxy

Names someone to make medical decisions for you if you cannot make them yourself.

Would you like a health care proxy?

Yes No Prefer to discuss

Health care agent — name

Relationship & phone

Address

Alternate agent — name

Relationship & phone

Address

3. Living Will

States your wishes about life-sustaining treatment if you have a terminal condition or permanent unconsciousness and cannot express your wishes. These are difficult questions — you can simply choose "prefer to discuss" and we will talk them through at your appointment.

Would you like a living will?

Yes No Prefer to discuss

Do you wish to donate tissue or organs?

Yes No Prefer to discuss

In that situation, should artificial nutrition (feeding) be withheld?

Yes No Prefer to discuss

Should artificial hydration (fluids) be withheld?

Yes No Prefer to discuss

Review & Submit

Anything Else?

Anything else you would like us to know before your appointment

How did you hear about us? (optional)

Your Answers

Please review your answers below. Use the Back button or the step names above to make changes.

Consent

Estate Planning Questionnaire

About You

Your Family

Guardians & Trustees for Minor Children

Income & Assets

Your Will — Who Gets What

Executor & Final Arrangements

Advance Directives

Review & Submit

Thank you!