CONFIDENTIAL PLANNING QUESTIONNAIRE

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

Liabilities other than mortgages :

Health Issues:

Do you/spouse have long term care insurance?

Existing Documents: Wills?

Power of Attorney?

Health Care Proxy?

Living Will?

Trusts

PreNuptial Agreement? PostNuptial Agreement?

Estate Planning Goals (check all that apply)
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?

Do any of your beneficiaries have money management problems?

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?

Executor of Will:

Primary

Secondary

Trustee of Asset Protection Trust/Supplemental Needs Trust/Estate Tax Trust

Primary

Secondary

Names of the beneficiaries of trust upon the death of the Grantor(s)