ESTATE PLANNING QUESTIONNAIRE
STUART A. RADER, Esq.
Rader & Coleman, P.L.
Attorneys at Law
2101 Northwest Boca Raton Boulevard, Suite 1
Boca Raton, Florida 33431
(561) 368-0545 Fax (561) 367-1725
www.raderandcoleman.com
stuart.rader@raderandcoleman.com
Date:
1. Full Name:
Date of Birth: Place of Birth:
Social Security No. U.S. Citizen: Yes No
Other Names known by:
Are you presently employed? Yes No For how long?
Occupation (former if retired):
Employer:
Business Address:
Office Telephone No.: Email Address:
Mobile Phone No. Fax No.:
2. Home Address: Resident Since
Street Address/P.O. Box:
City: State: Zip Code:
County: Home Telephone Number:
Other Residences:
3. Advisors:
Accountant:
Trust Officer:
Insurance Agent:
Investment Advisor:
4. Prior Marriages: Yes No
5. Names of children, whether natural or adopted;
A. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
B. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
C. Phone No.:
Date of Birth: SSN:
Name of Child's Other Parent:
Name of Child's Spouse (if any):
Address:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
Grandchild: Date of Birth: SSN:
6. Do you have any other relatives dependent upon you for support? Yes No
(If yes, give names and relationships):
7. Names and addresses of other or alternate persons to receive property:
.8. Please list any specific items or amounts that you wish to give to any individuals or organizations:
9. All other tangible personal property (automobiles, clothing, furniture, pictures, etc.) to be distributed to: (check one)
Children equally
Other (specify):
10. Do you have a present Will: Yes No (If yes, attach a copy)
11. Have you ever created a trust? Yes No
If yes, attach a copy and list approximate value: $
12. Do you have any obligations under a divorce decree from a prior marriage? Yes No
(If yes, attach a copy)
13. Have you ever received a substantial amount by inheritance? Yes No
If yes, when?
Approximate Amount: $
14. Are you a beneficiary of a trust that was created by someone else? Yes No
If yes, attach a copy and list approximate value: $
15. Do you anticipate receiving an inheritance? Yes No
If yes, give approximate amount: $
16. Have you given away more than $3,000 in money or property to any person in any single year after 1976 (or $20,000 in 1982 or later)? Yes No (If yes, list amounts by years below or on the reverse side)
Year: Amount: $
Year: Amount: $
17. Are you receiving or will you receive an annuity? Yes No
If yes, to who will the payments be made?
Is this a Life Annuity? Yes No
Will the amounts continue after your death? Yes No
For how long? What will the amount of each payment be?
18.a. Do you now or have you ever participated in a plan maintained by an employer that will provide benefits in the event of your retirement and/or death?
Yes No Not sure
b. If yes, have you made any elections with respect to beneficiary designations, survivor benefits, spousal rights, waivers, or forms of payment under your employer¿s plan(s)?
Yes No
19. Do you presently have, or were you ever a participant in a Qualified Plan or an IRA?
Yes No
20. Please attach copies of your designation of beneficiary form and your most recent IRA and/or retirement plan benefit statements.
21. Who will serve as your personal representative? (Indicate relationship to you.)
Alternate (if above person(s) unable to serve):
22. Your choice to act as guardian of your minor children (if applicable):
City and state of residence:
Alternate(s):
City and state of residence:
23. Do you have a safe deposit box? Yes No
If yes, where is it located:
Name(s) deposit box is listed under:
.24. Please circle any of the following states in which you have lived or acquired property while married:
|
Arizona |
Louisiana |
Texas |
|
California |
Nevada |
Washington |
|
Idaho |
New Mexico |
Wisconsin |
|
None |
|
|
25. Do you own any property in a foreign country? Yes No
26. Are you concerned that one or more of your children or grandchildren will not behave responsibly with money that you give them?
Yes No
27. Are any of your children or grandchildren attending private school, college, or graduate school?
Yes No
28. Do you have any relative who regularly incurs significant medical bills? Yes
