CONFIDENTIAL
ESTATE PLANNING QUESTIONNAIRE

Instructions. By filling out this form as completely as you can, you will help assure that the information is complete and accurate when you meet with the attorney. Thank you.

Fill out only what applies to you. When finished, click on "submit" at the end of this document. If you prefer, you can download the PDF, fill it out online, and then print it.

A. GENERAL INFORMATION

Home address:

Home phone:

City:

State:

Zip:

Client 1

Client 2

Full name: *

How do you want your name to appear in the documents?

Name(s) used in past:

Work telephone:

Cell phone:

E-mail address:

Occupation:

Birth date:

U.S. citizen?

YesNo

Wedding anniversary date:

Prior marriages?

YesNo

Former spouse No. 1 name:

Ended by spouse No. 1:
DeathDivorceAnnulmentNo

DeathDivorceAnnulmentNo

Year death/divorce spouse No. 1:

Former spouse No. 2 name:

Ended by spouse No. 2:
DeathDivorceAnnulmentNo

DeathDivorceAnnulmentNo

Year death/divorce spouse No. 2:

Are you named as trustee or executor?

YESNO

Whose trust or will?

Are you named as agent under a power of attorney?

YESNO

Whose power of attorney?

Do you have health concerns?

YESNO

Please explain:

Are you scheduled for an surgery?

YESNO

When?

Are you going on vacation soon?

YESNO

When?

Additional Questions:

1. Who may we thank for referring you to this office?

2. Do you have any specific bequests you wish to make?

Person/Organization

Amount or Asset

When To Be Given

3. Have you made any gifts of $10,000 or more in any one year to any one person?

YESNO

If Yes, please explain:

4. Do you wish to specifically disinherit an individual or group of people?

YESNO

If Yes, who?

5. Do you have some specific questions or concerns you would like to discuss? If yes, please note them here:

B. CHILDREN AND OTHER RELATIVES

Please note that children of your present marriage are listed first. Children of prior marriage(s), whether of yourself or your spouse, are listed separately. Please write in the "other information" space any other helpful information you would like the attorney to know such as if the child is adopted or has special needs because of developmental, physical or mental disability.

Children of Existing Marriage:

1. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

Other helpful information:

2. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

Other helpful information:

3. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email

Gender:

MaleFemale

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

Other helpful information:

Children of Prior Marriage

Full name:

Spouse:

Address:

Home phone:
]
Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Father:

Mother:

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

2. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Father:

Mother:

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

3. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Father:

Mother:

Child No. 1:

D.O.B.

Child No. 2:

D.O.B.

Child No. 3:

D.O.B.

Child No. 4:

D.O.B.

Other Important Family Members and Other People

Are there other important people in the lives of you and your spouse, such as a person dependent upon you for support, or a person whom you raised as a child but is not legally your child? (Note: an adopted child is legally your child and should be listed above.) If so, please list.

1. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Relationship to you:

Do you now or might you in the future provide financial support?

YesNo

If yes, monthly amount:

2. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Relationship to you:

Are you now, or might you in the future, provide financial support?

YesNo

If yes, monthly amount:

3. Full name:

Spouse:

Address:

Home phone:

Office:

Cell:

Date of birth:

Email:

Gender:

MaleFemale

Relationship to you:

Are you now, or might you in the future, provide financial support?

YesNo

If yes, monthly amount:

C. IMPORTANT DOCUMENTS

If you have executed any of the following documents, please provide your attorney with a copy if possible. If you cannot readily locate them, please be prepared to discuss their contents.

Client 1

Client 2

Copy Available?

Personal Documents:

Divorce Decree

YESNO

Premarital Agreement

YESNO

Community Property Agreement

YESNO

Marital Property Agreement

YESNO

Existing Estate Planning Documents:

Will

YESNO

Trust

YESNO

Power of Attorney For Asset Management

YESNO

Power of Attorney for Health Care

YESNO

Living Will or Directive to Physician

YESNO

Other Documents:

Funeral and Burial Arrangements

YESNO

Cemetery Plot

YESNO

Organ Donation Directive

YESNO

D. SAFETY DEPOSIT BOX

Financial Institution:

Branch:

Address:

Telephone No.:

Box No.:

Who are signatories?

E. KEY ADVISORS

Lawyer:

Name:

Firm:

Address:

Telephone No.:

E-mail address:

Purpose of representation:

Okay for attorney to contact?
YesNo

Accountant:

Name:

Firm:

Address:

Telephone No.:

E-mail address:

Okay for attorney to contact?
YesNo

Stockbrokers/Investment Advisor:

Name:

Firm:

Address:

Telephone No.:

E-mail address:

Okay for attorney to contact?
YesNo

Life Insurance Agent:

Name:

Firm:

Address:

Telephone No.:

E-mail address:

Okay for attorney to contact?
YesNo

Yes, I'd like to receive valuable information from the team at Johnston & Associates.

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Johnston & Associates

Estate Planning Questionnaire

CONFIDENTIAL ESTATE PLANNING QUESTIONNAIRE

A. GENERAL INFORMATION

Additional Questions:

B. CHILDREN AND OTHER RELATIVES

Children of Existing Marriage:

Children of Prior Marriage

Other Important Family Members and Other People

C. IMPORTANT DOCUMENTS

D. SAFETY DEPOSIT BOX

E. KEY ADVISORS

CONFIDENTIAL
ESTATE PLANNING QUESTIONNAIRE