Amrine Law - EP Questionnaire - Individual

Estate Planning Questionnaire for Individuals
  • Confidential Estate Planning Questionnaire
  • This questionnaire is designed to help us gather the information necessary to properly plan to protect your assets (or the assets of a family member or friend) during a time when there may be a need for Long-Term Care. Whether you are new or an established client, we have found this questionnaire extremely helpful and we ask your indulgence in completing it fully. Those questions that do not apply to you, your family, or your financial situation may simply be ignored.
  • A. Personal Information

  • B. Prior Marriage(s)

  • Example(s): 1. John Doe; 2. Bob Johnson
  • Example(s) 01/01/1990; 10/10/2010
  • Ex: Divorce: 01/01/1990
  • C. Children

  • D. Other Dependents


  • 1. Names and addresses of persons you wish to name as EXECUTOR and SUCCESSOR EXECUTOR of your will:
  • Please provide name and address of your EXECUTOR of your will:
  • Please provide name and address of your SUCCESSOR EXCECUTOR:
  • 2. Names and addresses of persons you wish that they administer your trust and act as trustees in the event of your incapacity or death (During your life you will act as your own trustee.)
  • Names and addresses of GUARDIANS OF MINORS (For children under age 18).
  • 4. Names and addresses of persons (other than your spouse) to act as your AGENT under a FINANCIAL POWER OF ATTORNEY. (Preferably the same persons as trustees of your trust to avoid conflicts.)

  • Bank/InstitutionAccount #Type of AssetValue 
    Add a new row
  • Brokerage CompanyAccount #Type of AssetValue 
    Add a new row
  • CreditorApproximate Amount Owed 
    Add a new row
  • G. Assets Distribution

  • It is preferred to distribute all your assets through the trust. Sometimes, however, you may wish to dispose of certain items of personal nature by your will.
  • Personal effects and tangible personal items will be distributed to the trust and held and administered by the trustee in accordance with the trust terms. You may wish to provide a schedule of items that go to a specific person.
  • H. Burial & End of Life Planning

  • The power of attorney for medical care gives the person you name as your agent the authority to make a wide range of medical decisions on your behalf. It also gives your agent access to your medical information and authority to fully participate with your treating physicians in deciding the care to be provided to you. Obviously, the person you designate to be your agent should be someone you trust with life and death decisions. Please be sure to discuss these decisions with your agent and with your doctor in detail.
  • Advance Health Care Directive and Power of Attorney for Health Care are important health care decision making documents. It appoints someone you name to make medical care decisions for you if you cannot make your own medical decisions. It applies to more situations than the living will, which addresses only continued life support if you have a terminal condition.
    Please select the paragraph that best expresses your wishes. If you would like to add other language or remove language, please feel free to do so. I also have language that comports with most religions. If you would like to see something that is more in line with the Christian, Catholic, or Jewish father, please call me.
  • Relief from Pain and Palliative Care
  • I. Organ Donation and Burial