Personal Financial Checklist


Checklist for Estate Planning

This checklist is designed to help you create an asset record in case of early death or disability. Don’t leave your family in the dark. Use this list to prepare your financial documents prior to consulting with an estate planning attorney.

PERSONAL DATA
Effective as of (Date)_________________________
Name:_____________________ DOB:___/___/___ SSN:____-___-_____
Address:__________________ Day phone:______ Eve. phone_______
__________________________ County of residence:______________
Employer:_________________ Retirement date:_____ Veteran:____
Spouse:___________________ DOB:___/___/___ SSN:____-___-_____
Employer:_________________ Retirement date:_____ Veteran:____
If currently in health care facility:
Name of facility: ______________________
Address: ______________________
______________________
Type of facility: ______________________
Level of care: ______________________
Date of admission: ______________________ If you entered this facility from another health care facility, date of your admission to this initial facility: ___________________
Funding source(s): ______________________
Your health status: ______________________
If spouse is currently in health care facility:
Name of facility: ______________________
Address: ______________________
______________________
Type of facility: ______________________
Level of care: ______________________
Date of admission: ______________________
If spouse entered this facility from another health care facility, date of admission to this initial facility:_____________________
Funding source(s): ______________________
Health status: ______________________

FAMILY INFORMATION
Names of children, with dates of birth, residence, marital status, and general information on special medical, educational, or other extraordinary personal or financial needs:
Is anyone (other than your spouse) dependent upon you for support? If so, please identify the person, and provide some general information as to the reason for, and extent of, support provided.
Do you or your spouse have a will or trust now? ___ Yes ___ No
Where is the will or trust being kept?
Who is your named successor trustee? Include the name, address and telephone number.

INFORMATION ABOUT YOUR PROPERTY
You should have copies of grant deeds and property tax statements for each piece of real property.
List your own and your spouse's property with estimated fair market values in the broad categories provided. Specify how the property is held;
for example:
"individually by me,"
"jointly with ______________________,"
"by ______________________ in trust for ______________________," etc.:
VALUE
- Family residence
Tax assessed value: ____________
Mortgage balance: ____________
Year of purchase: ____________
Purchase price: ____________
How held: ____________

- General household
furniture and furnishings ____________

- Household effects of special value (such as china, silver, art works, antiques, collections, etc.) ____________

- Automobiles
- Year: ____________
Make: ____________
Value: ____________
Loan balance: ____________
- Year: ____________
Make: ____________
Value: ____________
Loan balance: ____________

- Other real estate
Where? ____________
Tax assessed value: ____________
Mortgage balance: ____________
Year of purchase: ____________
Purchase price: ____________
How held: ____________

- Bank savings or money market accounts
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________

- Bank checking accounts
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________

- Bank certificates of deposit
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________

- Mutual funds
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________
Acct. No. _________________ _________________________

- Stocks and bonds:
- ______________________
Date of purchase: ______________________
Cost: ______________________
- ______________________
Date of purchase: ______________________
Cost: ______________________
- ______________________
Date of purchase: ______________________
Cost: ______________________
- ______________________
Date of purchase: ______________________
Cost: ______________________

- IRAs, Keoghs, 401(k) plans, annuities, etc

- Business interests (such as limited partnership, realty trusts, ownership of closely held corpora- tion, royalty rights, etc.)

- Prepaid funeral
burial account
burial insurance
plot
headstone

- Other assets (other than life insurance):
List life insurance on you or your spouse, specifying, for each policy, whether it is a whole life or term policy, the owner, beneficiary, on whose life the policy is written, the face amount of the policy, and its cash surrender value (less outstanding loans) if any:
KIND(whole/term) OWNER BENEFIC. LIFE FACE AMT. CASH VAL.
________ ________ ________ ________ ________ _______
________ ________ ________ ________ ________ _______
________ ________ ________ ________ ________ _______

Do either you or your spouse expect to inherit significant property or have a power of appointment under anyone else's will or trust? Yes [ ], no [ ]. If yes, prepare a brief explanation.

List your own and your spouse's debts, if any, other than any mortgage.
To Whom?
Amount Due

Are either you or your spouse the beneficiary of any trust? yes [ ], no [ ]. If yes, please enclose a photocopy of a signed version, if available, or provide whatever information you can on the terms and conditions of the trust, identity of the current trustee, amount of principal, etc.

Is any of the property or income of you or your spouse the subject of a legal proceeding or ownership dispute, under a lien or court order, or is otherwise inaccessible or non-marketable? yes [ ], no [ ]. If yes, please explain briefly:

During the last 30 months, have either you or your spouse made any large gifts ($750 or more in value), placed any property into trust, transferred any real estate or other property for less than fair market value, or removed or added names to joint accounts? yes [ ], no [ ]. If yes, please list each action and explain when and why the transfer was made:

Calculation of Monthly Income
This worksheet will help you calculate your monthly income and needs:

SOURCE YOU SPOUSE
Work Earnings _____________ ______________
Social Security Retirement _____________ ______________
Social Security Disability _____________ ______________
Supplemental Security Income _____________ ______________
Veterans' Benefits _____________ ______________
Private Pension _____________ ______________
Annuity _____________ ______________
Public Employment Pension _____________ ______________
Railroad Retirement _____________ ______________
Support from Spouse _____________ ______________
Regular Support from Others _____________ ______________
Unemployment Compensation _____________ ______________
Worker's Compensation _____________ ______________
Regular Income from Trust _____________ ______________
Rental Income _____________ ______________
Interest and Dividends _____________ ______________
Other Income (_____________) _____________ ______________

You should be able to provide a copy of the federal income tax returns for you and your spouse for the last two years.
If your spouse is in a medical facility, please answer the following questions, as you may be entitled to support for living expenses.

How much do you pay each month for:

$____________________ rent
$____________________ mortgage (including principal and interest)
$____________________ property taxes
$____________________ homeowner's or tenant's insurance
$____________________ required maintenance charges (for condominium or cooperative)
If you live in an apartment or condominium and have to pay separately for heat, calculate the average cost per month $______; for electricity $______; for natural gas $______; for telephone $______.

(i) Does a child, parent, sibling, or other family member currently live in your home? yes [ ], no [ ].
(ii) If you answered yes to (i), is any portion of your income or the income of your spouse directly or indirectly used to provide all or a portion of their support? yes[ ], no [ ].
(iii) If you answered yes to (ii), describe the circumstances, the reasons for the arrangement, and how it is being handled financially.
(iv) Provide information for each person to whom you or your spouse are furnishing support:

Your Health Insurance
Please check in the appropriate box and provide the following information regarding your health insurance:
______ Medicare for yourself (Number: _____________________)
______ Medicare for spouse (Number: ______________________)
______ Medicare Supplemental Insurance for self
(Company: _____________________)
(Number: ______________________)
______ Medicare Supplemental Insurance for spouse
(Company: _____________________)
(Number: ______________________)
______ Medicaid for yourself (Number: _____________________)
______ Medicaid for your spouse (Number: __________________)
______ Other health insurance for yourself?
(Company: _____________________)
(Number: ______________________)
______ Other health insurance for your spouse?
(Company: _____________________)
(Number: ______________________)

Work History of You and Spouse
Summarize the work histories of you and your spouse, particularly with regard to relative length of employment and relative earnings:

Did either you or your spouse come to the marriage with significant amounts of property or later individually acquire significant property, other than from work or investment earnings, such as by inheritance? yes [ ], no [ ]. If yes, explain:

Have either you or your spouse, during the last 90 days, had substantial medical expenses, such as nursing home or hospital bills, which have not been paid and are not expected to be paid by Medicare, MediCal insurance, long-term care insurance, or other insurance? yes [ ], no [ ]. If yes, please provide details and explain:

Have any of your children or brothers or sisters lived with you during the last two years? yes [ ], no [ ].

If so, describe the circumstances of the individual, the reason for the arrangement, and how it was handled financially:

To the extent not already noted above, describe any significant changes that you or your spouse anticipate occurring at any time over the course of the next five years with respect to your (i) personal, marital, or family situation, (ii) employment, or (iii) financial situation as it relates to your level of income, debt, or assets.

Veterans
Are you or your spouse a veteran?
If yes, provide the following information:
Serial Number, Dates of Service, VA Claim Number, Branch of Service.
Describe any veteran's benefits you or your spouse are now receiving:

TRUST STRUCTURE
1. Trustee: Manages your trust now; usually you (and your spouse).
2. Back-up Trustee #1: Steps in at your disability or death.
Name Address Telephone
3. Back-up Trustee #2
Name Address Telephone
4. Guardians for minor children: Responsible adult who will raise your minor children if something happens to you.
#1 Choice:
Name Address Telephone
#2 Choice:
Name Address Telephone

SPECIFIC GIFTS AND BENEFICIARIES
1. List any gifts (cash or a specific item) you would like to make to a charity, foundation, religious, or fraternal organization:
Name of organization Address Gift
2. List gifts of any specific items you want to give to someone (for example, gun collection to your son or a specific sum of $$).
Name of person Description of gift
3. Beneficiaries: Who do you want to receive the rest of your estate after the gifts have been distributed? Name of person/organization Percentage of estate
4. Alternate beneficiaries: If a beneficiary predeceases you, to whom do you want their share to go?
Standard (to decedent's living issue)_____ To the surviving named beneficiaries ______ Other ______
If other, please specify:
5. Age at which you want your primary or alternate beneficiaries to receive their inheritance?
6. List any children that you would like to specifically omit as beneficiaries:
Name

QUESTIONS FOR DURABLE POWERS OF ATTORNEY
1. Who do you want to make financial decisions for you if you are incapacitated?
Spouse _____ or Person other than spouse (name): _____________________________________
Husband's Alternate: ___________________________________________
Wife's Alternate: ___________________________________________
2. Who do you want to make health care decisions for you if you are incapacitated?
Spouse _____ or Person other than spouse (name): _____________________________________
Husband's Alternate: ___________________________________________
Wife's Alternate: ___________________________________________
3. Do you want artificial life support if there is no reasonable hope of recovery?
___ Yes ___ No ___Other (please specify)
4. Do you wish to be an organ donor? ___Yes ___ No
5. Wishes regarding your remains: _____burial ______cremation ______ let executor make decision.
Documents You Will Need:
You should have copies of each of the following documents before you meet with your estate planning attorney.
1. Will, Codicil, Trust Agreements
2. Real Estate Deeds, Appraisals
3. Admission Agreements to hospitals and health facilities
4. Divorce Decrees, Prenuptial Agreements, Adoption Papers
5. Guardianship documents
6. Living Will, Health Care Declaration or Power of Attorney, Durable Powers of Attorney.
7. A list of full names, addresses, telephone numbers of people who have a part in your planning as executors, trustees, beneficiaries of your estate, helpers, and advisors.
8. Retirement plans, including any forms designating beneficiaries.

Please contact us for more information here.