Estate Questionnaire | Totman Law

Estate Questionnaire

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Husband Personal Information
Full Legal Name
First Last
Preferred Name
First Last
Home Address
Street Address Address Line 2 City State ZIP Code

County
Email

Alternate Email

Phone
Mobile Phone
Work Phone
DOB

U.S. Citizen?
Yes
No
Asset Distribution
Please describe generally how you want your assets distributed (e.g. to all my children, equally):
Specific Bequests
Do you have any specific bequests (e.g., I leave my ’77 Corvette to my son, Mike of Raleigh, North Carolina)?
Yes
No
Specific Bequest Description
If yes, please describe:
Distribution of Assets
If none of your children survived you and your spouse, how would you want to distribute your assets (e.g., to a named charity or to specific persons)?
Charitable Organization Bequests
Do you wish to make bequests to any charitable organization?
Yes
No
Charitable Organization Bequest Description
If yes, please list name(s) and amount / description:
Wife Personal Information
Full Legal Name
First Last
Preferred Name
First Last
Home Address
Street Address City State ZIP Code

County
Email

Alternate Email

Phone
Mobile Phone
Work Phone
DOB

U.S. Citizen?
Yes
No
Asset Distribution
Please describe generally how you want your assets distributed (e.g. to all my children, equally):
Specific Bequests
Do you have any specific bequests (e.g., I leave my ’77 Corvette to my son, Mike of Raleigh, North Carolina)?
Yes
No
Specific Bequest Description
If yes, please describe
Distribution of Assets
If none of your children survived you and your spouse, how would you want to distribute your assets (e.g., to a named charity or to specific persons)?
Charitable Organization Bequests
Do you wish to make bequests to any charitable organization?
Yes
No
Charitable Organization Bequest Description
If yes, please list name(s) and amount / description.

Children and Beneficiaries
Full Legal Name
First Last
Preferred Name
First Last
Relationship
Relationship (e.g. child of H or W or both, adopted, step-child, grandchild, etc.):
DOB

U.S. Citizen?
Yes
No
Spouse's Name
First Last
Children's Names:
Inheritance Instrucions
Specific Instructions Regarding Inheritance:
Additional Comments
(e.g. special needs):

Designated Persons
In this section, please identify the persons designated to act on your behalf in the listed capacities.
Executor: An executor is the person named in your will who is given the legal responsibility to administer your estate and take care of your remaining financial obligations.
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife
Trustee for Minor Children Trust: Your will may include provisions putting assets to be disbursed to minor children into trust until they reach a determined age. The named trustee will administer the trust assets in accordance with the will.
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
At what age would you like assets distributed in full to your children?
(e.g. 18, 25, etc.)
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife
At what age would you like assets distributed in full to your children?
(e.g. 18, 25, etc.)
Guardian: The will should identify one or more persons to serve as guardian of any minor children if you and your spouse pass away. Doing so allows you to make this decision, rather than leaving it in the hands of the courts. You can name a single guardian or co-guardians (e.g. sister and brother-in-law).
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife

Guardian: This person will make financial decisions for you in the event you are unable to do so for yourself.
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
Type of power of attorney?
Durable
Springing
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife
Type of power of attorney?
Durable
Springing
Health Care Power of Attorney: This person will make medical decisions for you in the event you are unable to do so for yourself.
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
Type of power of attorney?
Durable
Springing
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife
Type of power of attorney?
Durable
Springing
Trustee: If your estate plan will incorporate trust planning (e.g. revocable or irrevocable trust), the trustee will administer the trust.
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Husband 2nd Alt. Executor
Relationship to Husband
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Wife 2nd Alt. Executor
Relationship to Wife

Healthcare Decision-Maker for Children: If you and your spouse are unavailable for a period of time, who do you want to make these decisions for your children? It may
Husband First Choice
Relationship to Husband
Husband 1st Alt. Executor
Relationship to Husband
Wife First Choice
Relationship to Wife
Wife 1st Alt. Executor
Relationship to Wife
Additional Questions
Have you or your spouse previously engaged in estate planning?
(e.g. will, trust, powers of attorney, etc.)
Yes
No
If yes, please provide a brief description and date:
Date

When did you establish residency in North Carolina?
If you have ever been a resident outside North Carolina during your present marriage, provide the county, state, and approximate dates of each residency:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Range
Have you or your spouse ever been divorced or widowed?
Yes
No
Name
First Last
Date

Do you, your spouse or any dependents or relatives have any health concerns or special educational, medical, financial, or other personal needs?
Yes
No
If yes, please describe:
Do you have any additional dependents for whom you are or be will be providing support?
Yes
No
If yes, please describe:
Are you or your spouse receiving social security or disability benefits?
Yes
No
Have you or your spouse ever filed federal gift tax returns?
Yes
No
Are you or your spouse making annual gifts to anyone?
Yes
No
Have you and/or your spouse ever signed a pre- or post-nuptial agreement?
Yes
No
If Yes, please provide a copy.
Do you or your spouse serve as custodian or trustee of assets of others?
Yes
No
If yes, please describe:
Have you or your spouse received or do you expect to receive any substantial gifts or inheritances?
Yes
No
If yes, please describe:
Do you own unique assets, like antiques or works of art, which may require special consideration or valuation?
Yes
No
If yes, please describe:
Do you have any special requests regarding your funeral, burial, cremation or the disposition of your remains?
Yes
No
If yes, please describe:
Would you like to leave instructions regarding your wishes for end-of-life medical care, in case you become unable to communicate their decisions?
(i.e., a living will or healthcare directive)
Yes
No
Do you think you would wish to receive medical treatment which will only postpone the moment of your death from an incurable and terminal condition or prolong an irreversible coma?
Yes
No
PLEASE NOTE: We will talk in greater detail about questions 14 and 15, including options, questions and concerns, but please provide an initial answer now as best you can.
Do you and/or your spouse wish to discuss additional trust planning, tax planning, charitable giving, special needs planning or other special concerns?
Yes
No
If yes, please describe:

Advisors
Please provide the name, company info, phone and email information for the followiong, if applicable.
Attorney:
Name
First Last
Company
Phone
Email

Accountant:
Name
First Last
Company
Phone
Email

Financial Planner
Name
First Last
Company
Phone
Email

Life Insurance Agent
Name
First Last
Company
Phone
Email

Personal Banking
Name
First Last
Company
Phone
Email

Business Banking
Name
First Last
Company
Phone
Email

Other
Name
First Last
Company
Phone
Email

Asset Summary
The purpose of this section is to determine an approximate value of the estate, which will help identify needs and options for the intended estate plan. For each asset category, please provide an estimated value or approximate balance for assets held by you and your spouse, as well the total debt against such assets. This will include assets held individually by either spouse and assets held jointly. Depending on the results of this summary, additional and more detailed information may be required to properly determine appropriate estate planning needs and structure.
Real Estate
Estimated Value/Approximate Balance
Loan/Debt Balance
Cash Accounts
Estimated Value/Approximate Balance
Loan/Debt Balance
Investment Accounts/Mutual Funds
Estimated Value/Approximate Balance
Loan/Debt Balance
Stocks and Bonds
Estimated Value/Approximate Balance
Loan/Debt Balance
Automobiles (e.g. cars and boats)
Estimated Value/Approximate Balance
Loan/Debt Balance
General Household Items
Estimated Value/Approximate Balance
Loan/Debt Balance
Special Household Items (e.g. art)
Estimated Value/Approximate Balance
Loan/Debt Balance
IRA's, 401(k) plans, annuities, etc.
Estimated Value/Approximate Balance
Loan/Debt Balance
Life Insurance
Estimated Value/Approximate Balance
Loan/Debt Balance
Notes and Other Receivables
Estimated Value/Approximate Balance
Loan/Debt Balance
Partnership and Business Interests
Estimated Value/Approximate Balance
Loan/Debt Balance
Oil, Gas, Mineral and Water Interests
Estimated Value/Approximate Balance
Loan/Debt Balance
Anticipated Judgments (from suits)
Estimated Value/Approximate Balance
Loan/Debt Balance
Anticipated Judgments (from suits)
Estimated Value/Approximate Balance
Loan/Debt Balance
Other Assets
Estimated Value/Approximate Balance
Loan/Debt Balance
Additional Debts
Please identify the total (estimated) amount owed on any debts, excluding any included above and consumer debts that are paid off each month:
Total Amount Owed

Contact

Dominic Totman, Attorney at Law
Raleigh, NC

Phone: 919.539.9590
Email: dominic@totmanlaw.com

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