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ESTATE PLANNING SERVICE

By Victoria Carroll,2014-07-10 15:30
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ESTATE PLANNING SERVICE ...

     Estate Planning Service

    Decker and Associates, Inc. is pleased to offer this client service. D&A has assembled estate planning attorneys

    who understand our firm’s desire for an integrated financial, investment and estate plan. The fees for the

    service are listed on page 9 of this form. Please note, the information requested in this form is designed to

    assist your estate planning attorney in creating an appropriate estate plan for you, and it will likely be the case

    that some of your answers will not be incorporated into your estate plan.

    Preliminary Information

    Please Use WORD to complete this form. If Not Applicable, note NA. Today’s Date Your Information

    Last Name First Name Middle Name Suffix (Jr., Sr., etc.) Citizen of Date of Birth (M/D/YYYY) Social Security Number

If Married, Spouse’s Information

    Last Name First Name Middle Name Suffix (Jr., Sr., etc.) Citizen of Date of Birth (M/D/YYYY) Social Security Number Home Address City State Zip Code County Duration of Residence in State Home Phone Home E-mail Address Mail Documents to Home Address - Employer Position

    Address City State Zip Code

    Your Business E-mail Address

    Phone Fax Cell Phone

    Spouse’s Employer Position

    Address City State Zip Code

    Business E-mail Address

    Phone Fax Cell Phone

    Children

    Full Name Date of Marital # of Parents if not clients

    Birth Status children

    Single Date

    Single Date

    Single Date

    Single Date

    Single Date

    http://www.DeckerUSA.com Estate Planning Form Page 1 of 15 (07/10/10)

If you have more than 5 children, please enter information on the additional children below.

Is any beneficiary receiving government benefits? YES If YES, who

    Is any beneficiary physically impaired or mentally handicapped? YES If YES, who

    Have any of your children died leaving heirs? YES If YES, who

    If ―YES,‖ complicated provisions may need to be added to your documents, the cost of which will be

    discussed with you and with your agreement, billed to you on an hourly basis.

    Marriage date (M/D/YYYY) If this is not your only marriage and you have children, please indicate the parent of each child:

    Financial Statement

    ASSETS & LIABILITIES Ownership U.S. Value Foreign Debt

    Value C=Community Property H = Husband’s Separate Property W=Wife’s Separate Property

     C Cash & Savings

    C Life Insurance on You

    C Life Insurance on Spouse

    C Installment Notes

    C Stocks

    C Stock Options

    C Bonds

    C