Estate Planning Estate Planning Questionnaire Contact Information Your Name Spouse's Name Street Address City State ZIP) Phone Your Email (required) How many children do you have? 1234 or more Are any of your children under 18? YesNo Are you currently employed? Full-TimePart-TimeSelf-EmployedRetired Inventory of Assets Safe Deposit Box YesNo Life Insurance Policy YesNo Real Estate in Florida YesNo Real Estate outside of Florida YesNo Brokerage Account YesNo Retirement Account YesNo Annuity YesNo Long Term Health Care Insurance YesNo Checking/Money Market Account YesNo Savings Account YesNo Certificate of Deposit YesNo Automobile YesNo Current Estate Plan Pick One: Will prepared within past 5 yearsWill prepared more than 5 yearsRevocable Trust prepared within past 5 yearsRevocable Trust prepared more than 5 years Have arrangements been made for any of the following? Durable Power of Attorney YesNo Health Care Surrogate Delegation YesNo Living Will Delegation YesNo What would be the most convenient time for us to contact you? MorningAfternoonEvening
