Estate Planning Questionnaire

Full Legal Name

Date of Birth

Occupation

SSN

Full Legal Name

Date of Birth

Occupation

SSN

Address

Contact Methods

Previous Advisors
The attorneys at The Reynolds Law Group look forward to working in cooperation with your current team of advisors. We will contact them regarding your matters only with your authorization.
CPA
Financial Advisor
Insurance Agent
Other Advisor/Attorney

Children
Name DOB Sex Marital Status Number of Children

Other Beneficiaries
Name Sex Relationship Status

1. Agent/Attorney-in-fact for your General Power

The General Power of Attorney grants your Agent the power to act on your behalf (as if he or she were you) in order to manage your financial affairs and pay your bills. This is particularly important if you become incapacitated or if for any other reason you are unable to sign your name.

Named Agent Client Spouse
First Agent:
First-Co Agent (If Any):
Second Agent:
Second-Co Agent (If Any):

2. Agent for your Medical Power of Attorney

This agent has specific powers to consult with your health care providers and make health care decisions for you when you are unable.

Named Agent Client Spouse
First Agent:
First-Co Agent (If Any):
Second Agent:
Second-Co Agent (If Any):
Comments/Questions

3. Guardian of Minor or Incapacitated Children

Please provide your nominees for individuals to be named as guardian(s) of your minor or incapacitated children.

First Choice
Second Choice

4. HIPAA Medical Records and Information Release Authorizations

This release authorizes the hospital or other medical providers to release information or records to certain family members or others you designate.

Authorized Parties Client Spouse
First Party:
Second Party:
Third Party:

5. Naming Your Executor

The Executor, also known as the Personal Representative, is the person named in a will to handle to property of someone who has died. The Executor collects the probate property, pays debts and taxes, and then distributes what is left, as specified in the will. The Executor also handles any probate court proceedings (if needed), submits required reports, and notifies people and organizations of the death.

Executor Client Spouse
First Choice:
Co-Executor (If Any):
Second Choice:
Co-2nd Executor (If Any):
Comments/Questions

6. Name Your Trustee (Complete for Trusts ONLY - The Trustee is often the same as the Executor)

A Trustee’s purpose is to safeguard the trust and distribute trust income or principal as directed in the trust document. A Trustee has complete control over the assets in the trust. Usually, you are the TRUSTEE of your own revocable living trust, ensuring that during your lifetime you retain complete control over the assets in the trust. You can change, amend or revoke your revocable living trust at any time during your lifetime. A husband and wife usually serve as CO-TRUSTEE. You will also need to name a SUCCESSOR TRUSTEE who takes control over your trust at the death or incapacity of the initial TRUSTEE.

Trustees Client Spouse
Initial Trustee:
Co-Trustee:
1st Successor Trustee:
Co-1st Successor Trustee (If Any):
2nd Successor Trustee:
Co-2nd Successor Trustee (If Any):

Approximate Current Value Client Spouse Joint Title
Bank Accounts (checking/savings/money market) Investment/Brokerage Accounts (non-IRA assets) Bonds (held directly, e.g., savings bonds )/Bank CD’s Annuities Stocks (held directly in certificate form or a DRIP) Life Insurance Death Benefit Amount (all policies) Cash Value of Life Insurance (all policies) Residential Real Estate Commercial or Investment Real Estate Personal Property (cars, boat, personal effects, etc.) Interests in Corporations, Partnerships, LLCs, etc Value of Loans Being Repaid to You by Others Retirement Accounts (401(k)s, IRAs, Roth IRAs, etc.) Miscellaneous Assets (coins, art, antiques, etc.) TOTAL ASSETS TOTAL LIABILITIES (Mortgages and unsecured debt/credit cards) NET WORTH ESTIMATED ANNUAL INCOME (all sources)

1. Do you or your spouse own real property in any state other than Virginia?

Yes No

2. Have you or your spouse previously been married?

Yes No

3. Have you or your spouse signed a pre-nuptial or post-nuptial agreement?

Yes No

4. Are you or your spouse the current beneficiary of anyone else's trust?

Yes No

5. Are you or your spouse currently making annual gifts to anyone?

Yes No

6. Have you or your spouse ever filed a gift tax return?

Yes No

7. If married, have you and your spouse ever lived in a "community property" state? (Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Texas, Washington or Wisconsin)

Yes No

8. Are you interested in making charitable gifts at death?

Yes No

9. Do any of your children or beneficiaries have special educational, medical, or physical needs or receive any government benefits for support?

Yes No

10. Do you have existing wills, trusts, powers of attorney or other estate planning documents?

Yes No

11. Do you or your spouse have any significant health issues or concerns?

Yes No