CONFIDENTIAL PLANNING QUESTIONNAIRE

    NOTE: Write all names as you want them to appear on the legal documents.

    YesNo

    Assets (Approx. Dollar Amount):

    Self

    Spouse

    JOINT

    Principal Residence

    Other Real Estate

    Stocks

    Government Bonds

    Mutual Funds

    Savings Accounts

    Checking Accounts

    Certificates of Deposit

    Annuities

    IRA/KEOGH/401K

    Other

    Other

    TOTAL ASSETS

    Balance of mortgage(s):




    Avoid Probate?Protect Assets in the event my spouse or I require Long Term Care?Ensure that assets are protected in the event that a beneficiary divorces?Reduce estate tax exposure?Reduce capital gains tax exposure?Review existing Long Term Care Insurance coverage?Ensure that any future needed Long Term Care is provided in my home?Upon death of first spouse, ensure that some or all of the couple’s assets are not given to new spouse?Avoid ‘blended family conflicts’ upon death of first spouse?Protect assets for the benefit of a disabled beneficiary?

    INFORMATION FOR DOCUMENTS

    Who do you wish to appoint to make healthcare decisions for you in the event that you are unable to communicate?

    Who do you wish to appoint to make financial decisions for you in the event that you are unable?