Existing Estate Planning & Health

Documents you already have in place, and health status.

Existing Document	You	Spouse	Date Executed

Assets Transferred/Gifted in Last 60 Months — Amount

Gift Date

Burial Plot or Funeral Plan?

Yes No

If Yes, Where is the Plot?

Health Status

Your health status plays an important role in designing an estate plan best suited for you and your loved ones.

Your Current Health Status

Good Concern Problem

Spouse's Current Health Status

Good Concern Problem

Your Specific Concern/Problem

Spouse's Specific Concern/Problem

What would completing your estate planning accomplish for you?

What do you see as your biggest risk if you don't complete your estate plan?

Rank Your Priorities

Rate the importance of each issue to you: 1 = Low, 10 = High.

Issue	Rank

Other Named Persons or Entities

Siblings, charities, churches, executors, trustees, or anyone else named in your plan.

Planning Questions

Please answer to the best of your ability.

Distribution Wishes

In general, how do you want your estate distributed among your beneficiaries after the death of both of you?

Any specific concerns (not already mentioned) regarding distribution of your estate?

Financial Information

Please provide the total amount for each item and indicate ownership. Figures are estimates.

Asset Information As Of (Date)

Monthly Income

Source	You	Spouse	Joint	Total

Assets

Type of Asset	You	Spouse	Joint	Total

Annuities

Original Amount

Year Purchased

Current Value

Life Insurance

Death Benefit

Cash Value

Total Value (Excl. Death Benefit)

Liabilities

Type	You	Spouse	Joint	Total

Business Interests

Type	You	Spouse	Joint	Total

Corporation Type

S-Corp C-Corp

Other

Type	You	Spouse	Joint	Total

Total Monthly Living Expenses

Additional Comments

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Personal Information