ESTATE PLANNING AND WILL/TRUST INFORMATION FORM
DUDLEY
AND SMITH, P.A.
2602
U.S. Bank Center
101
East Fifth Street
St.
Paul, MN 55101
Tel:
(651) 291-1717
Fax: (651) 223-5055
PLEASE PRINT, COMPLETE AND MAIL OR
COPY, COMPLETE AND E-MAIL
Date:
LEGAL SERVICES PLAN MEMBERS ONLY.
1. Plan Provider (Prudential, Hyatt, ARAG Group, Legal
Services Plan, etc.)
2.
Employer
3.
Plan/Authorization Number
1. TESTATOR/TESTATRIX
A. HUSBAND
OR SINGLE PERSON
Name:
Address:
Phone Number: Home Work
Date of Birth: County of Residence __________________
Your Social Security # U.S. Citizen? Yes No
B. WIFE
Name:
Address:
Phone Number: Home
Work
Date of Birth: County of Residence ___________________
Your Social Security # U.S. Citizen? Yes No
2. CHILDREN - please list all children. If you do not plan to provide for a child in your will, the child must be specifically omitted by name. (Use back or attach a separate page if more space is needed):
Name Date of Birth Married Name Address
A. Have any children received an advance on their inheritance or are any children financially indebted to you? Yes No If so, how do you wish to address this matter in your will?
B. Is there any reason to treat your children other than equally? Yes No If so, how do you wish to address this matter in your will?
C. Are any of the children spendthrifts? Yes No If so, how do you wish to address this matter in your will?
D. Are any of the children under a disability? Yes No If so, how do you wish to address this matter in your will?
E. Please indicate if you have been married previously. Yes No (If so, please give any details on back you believe to be pertinent to the drafting of your will.)
3. If any child should predecease parent, should his/her share pass through to his/her children?
4. Who should be GUARDIAN of your minor children? (A guardian has physical and/or legal control over your children until they reach the age of 18). The surviving spouse is automatically guardian unless otherwise determined by the court.
A. First Choice:
Name(s) Address: ________________________________________________________________________
Telephone Number: Relationship (if any):
B. Alternate:
Name(s)
Address:
Telephone Number: Relationship (if any):
5. If you want a TRUST or believe a trust may be necessary, please indicate who the trustee(s) should be. (A trustee manages the assets for your children or other beneficiaries until they reach specified ages. If you do not establish a trust, children inherit at age 18. You may name an individual, bank or trust company or both.)
A. First choice:
Name(s) Address:
Telephone Number: Relationship:
B. Alternate trustee:
Name(s) Address:
Telephone Number: Relationship:
C. Terms of distribution (education, marriage, etc.)
D. Age(s) for distribution to children from the trust (Ex. 1/2 @ age 25, 1/2 @ age 30)
6. How should your estate be distributed if your spouse and/or
children do not survive you or if you are not married or
if you do not have children. (Ex: family,
charity, etc.)
7. Who should be PERSONAL REPRESENTATIVE ("executor") of your estate? (A Personal Representative is responsible for probating your will, paying your debts, collecting your assets, and settling your estate.)
Husband/Single Person
A. First choice (Spouse is normally named first): Address:
Telephone Number: Relationship:
B. Alternate: Name Address:
Telephone Number: Relationship:
C. Second Alternate: Name Address:
Telephone
Number:
Relationship:
Wife
A. First choice (Spouse is normally named first): Address:
Telephone Number: Relationship:
B. Alternate: Name Address:
Telephone Number: Relationship:
C. Second Alternate: Name Address:
Telephone
Number:
Relationship:
THE PURPOSE FOR THE FOLLOWING INFORMATION IS TO HELP DETERMINE THE PROPER WILL OR TRUST NECESSARY TO EFFECTIVELY PROTECT YOUR FINANCIAL AND OTHER INTERESTS. PLEASE COMPLETE TO THE BEST OF YOUR KNOWLEDGE. APPROXIMATE VALUES AND INFORMATION IS FINE.
8. Do you own your home? ____ Yes ____ No If so, please indicate the following:
A. Names of all owners B. Approximate "fair" market value of homestead (This may be higher than tax value.)$ C. Amount of any mortgage, contract for deed, etc.
9. Do you own any other real estate? If so, please list the following:
A. Address/Legal Description:
B . Approximate fair market value $
C. Names of all owners: D. Amount of any mortgage, contract for deed, etc. E. Your wishes for its disposition upon your death:
(If you have additional
properties, please list on the back including the above requested
information.)
10. Bank accounts and deposits (Use back if more space is needed):
A. Checking: Name of Bank Owner(s) Average balance $
B. Savings: Name of Bank Owner(s) Average balance $
C. Savings:
Name of Bank
Owner(s)
Average balance $
D. Money Market: Name of Fund Owner(s) Average balance $
E. Mutual Fund: Name of Fund Owner(s) Average balance $
F. Individual Retirement Account: Name of Fund Owner Average balance $
Beneficiary
G. Individual Retirement Account: Name of Fund Owner Average balance $ Beneficiary
11. Life Insurance (Use back if more space is needed):
A. Name of Company and Policy number, if known B. Insured/Owner Amount $
C. Primary Beneficiary(ies) D. Secondary Beneficiary(ies)
A. Name of Company and Policy number, if known B. Insured/Owner Amount $ C. Primary Beneficiary(ies) D. Secondary Beneficiary(ies)
A. Name of Company and Policy number, if known B. Insured/Owner Amount $ C. Primary Beneficiary(ies) D. Secondary Beneficiary(ies)
A. Name of Company and Policy number, if known B. Insured/Owner Amount $ C. Primary Beneficiary(ies) D. Secondary Beneficiary(ies)
12. Securities, Stocks and Bonds (Use back if more space is needed):
A. Name of Company B. Owner(s) Approximate Value $
A. Name of Company &