ESTATE PLANNING QUESTIONNAIRE Estate 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 AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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 Information Any 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 Information Any 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 Information Is the total value of your estate, including life insurance and retirement accounts, greater than $10,000,000? Yes No Check if you have the following assets: Bank accounts Residence Investment real estate Stocks and/or bonds Retirement accounts Small business ownership Vehicles Additional Information 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 incapacitated Explanation of Additional Information If you checked any boxes under Additional Information, please provide more detail below reCAPTCHA ASK A QUESTION
