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?

    Are any of your children under 18?

    YesNo

    Are you currently employed?

    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:

    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?