ESTATE PLANNING QUESTIONNAIREEstate Planning Questionnaire Family Information 1st Client Full Name * Age Birthdate Marital Status Single Married Divorced Widowed Marriage Date 2nd Client Full Name Age Birthdate Marital Status Single Married Divorced Widowed County of Residence Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country 1st Client Email * 2nd Client Email 1st Client Home Phone Cell Phone 2nd Client Home Phone Cell Phone Children (born or adopted during your current marriage) Name Birthdate Name Birthdate Name Birthdate Name Birthdate Name Birthdate Additional 1st Client InformationAny prior marriages terminated by death, divorce or annulment? Yes No Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Do you have children born or adopted during a prior marriage or relationship? Yes No Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Additional 2nd Client InformationAny prior marriages terminated by death, divorce or annulment? Yes No Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Name of Prior Spouse if any Marriage Terminated By Year Marriage Ended Do you have children born or adopted during a prior marriage or relationship? Yes No Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Name if any Birthdate Name of Other Parent Financial InformationIs the total value of your estate, including life insurance and retirement accounts, greater than $10,000,000? Yes NoCheck if you have the following assets: Bank accounts Residence Investment real estate Stocks and/or bonds Retirement accounts Small business ownership VehiclesAdditional InformationI, (My spouse) am (is) a health care professional or first responder living in Travis or a contiguous county. Yes No If so, provide the name of your employer in the box below. Please indicate all of these which apply to you or our spouse or life partner. I (We) own real estate outside of Texas I (We) need to provide for the care of a parent I (We) have a child with special needs I (We) anticipate moving out of Texas soon I (We) want to disinherit person(s) named below I (We) anticipate a challenge to my (our) will I (We) are retired or nearing retirement I (My Spouse) have (has) a terminal illness or will cause me (my spouse) to become incapacitatedExplanation of Additional Information If you checked any boxes under Additional Information, please provide more detail below reCAPTCHA If you are human, leave this field blank. ASK A QUESTION
