Estate Planning Interview

Date

Family Information

Client Name*

Age*

Date of Birth*

Marital Status*

Single

Married

Divorced

Spouse's Name

Age

Date of Birth

Street*

City*

State*

Zip*

Client Email

Spouse Email

Client Home Phone*

Client Cell Phone

Client Work Phone

Spouse Home Phone

Spouse Cell Phone

Spouse Work Phone

Children

Born or adopted during your current marriage.

Name

Date of Birth

Add Remove

Additional Client Information

Any prior marriages terminated by death, divorce or annulment?

Yes

No

If Yes, please answer additional information.

Section

Name of Prior Spouse

Marriage Terminated By

Death

Divorce

Annulment

Year Marriage Ended

Add Remove

Section

Any children born or adopted prior to current marriage?

Yes

No

If Yes, please enter information for each child.

Section

Name

Date of Birth

Name of Parent

Add Remove

Additional Spouse Information

Any prior marriages terminated by death, divorce or annulment?

Yes

No

If Yes, please answer additional information.

Section

Name of Prior Spouse

Marriage Terminated By

Death

Divorce

Annulment

Year Marriage Ended

Add Remove

Section

Any children born or adopted prior to current marriage?

Yes

No

If Yes, please enter information for each child.

Section

Name

Date of Birth

Name of Parent

Add Remove

Financial Information

Is the total value of your estate, including life insurance and retirement accounts, greater than $10,000,000?

Yes

No

Additional Planning Information

Please select all of these which apply to you or your spouse, if married.

Checkboxes

I (We) own real estate outside Texas

I (We) want to disinherit someone

I (We) need to provide for the care of a parent

I (We) anticipate a challenge to my (our) will

I (We) have a child with special needs

I (We) are retired or nearing retirement

I (We) anticipate moving out of Texas soon

I (My spouse) have (has) a chronic illness which is terminal or will render me (my spouse) incapable of caring for personal or financial needs

Explanation of Additional Information

If you checked any boxes under Additional Planning Information, please provide more detail below.

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Family Information

Children

Additional Client Information

Section

Section

Section

Additional Spouse Information

Section

Section

Section

Financial Information

Additional Planning Information

Explanation of Additional Information

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