Estate Planning Questionnaire

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INTRODUCTION:

The following Questionnaire may seem imposing and unnecessarily lengthy; however, much of the requested information may not apply. The requested information is necessary to comply with the requirements of the probate court and to prepare an accurate estate tax return.

The following information will be treated as strictly confidential. Please do not hesitate to call us if you have any questions regarding the Questionnaire.

Decedent's Full Name
If Widow(er), Name of Deceased Spouse
Is there a valid will?

PERSONAL REPRESENTATIVE INFORMATION:

Name of Executor/ Personal Representative
Address

BENEFICIARY INFORMATION:

SPOUSE:

Name
Address

CHILDREN:

Name
Address
Name
Address
Name
Address
Name
Address

GRANDCHILDREN (if beneficiary):

Name
Address
Name
Address

ASSETS OF THE DECEDENT

Real and tangible personal property located outside of Pennsylvania:
List details for each one.
List details for each one.
Pennsylvania real estate:
List details for each one.
List details for each one.
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Stocks and bonds:

Please provide a complete description of stocks, including the number of shares, common or preferred. For bonds, please provide the face amount of each bond, interest rate, and maturity date.

If held in a brokerage account, please provide a copy of the statement for the month of death.

List details for each one.
List details for each one.
Were any accounts Transfer on Death (TOD)?
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Cash, bank accounts, notes and mortgages

Please provide a list of all bank accounts, promissory notes, mortgages payable to the decedent and cash on hand. Please provide a copy of bank statements for the month of death, and a copy of the promissory note or mortgage and amortization schedule, if any. If not available, please provide the names(s) on account, the name and address of the bank, and account number.

List details for each one.
List details for each one.
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Life insurance on the decedent's life and life insurance owned by the decedent on the life of another

Please provide the name of the insurance company, address, policy number, amount, and named beneficiary. If the insurance company sends a Form 712 - Life Insurance Statement upon payment of the claim, please attach a copy.

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Tangible personal property

(automobiles, personal effects, household furnishings, boats, etc.)

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Other miscellaneous property

If you answer "yes" to any of the following questions, please submit full details.

Did decedent own an interest in a partnership or unincorporated business?
Did decedent own any jewelry, stamp collections, coin collections, etc. having either artistic or intrinsic value?
Has anyone (surviving spouse, children, etc.) received any money or property as a result of the decedent's death (i.e., death benefit, unpaid salary or vacation pay, bonus, award, etc.)?
Did the decedent have a safe deposit box?
Did the decedent at the time of death have any power, beneficial interest or trusteeship in a trust that was not created by the decedent?
Was the decedent a trustee or beneficiary of any trust whether created by him/her or another person?
Did decedent create any trusts during his/her lifetime? If yes, please provide details and a copy of the trust.
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Transfers during decedent's life

If you answer "yes" to any of the following questions, please submit full details.

Did the decedent make any gifts or fund any 529 plans within the last five years?
Did the decedent ever file Federal Gift Tax Returns? If so, please provide copy.
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Powers of Appointment
Did the decedent ever possess, exercise, or release a power of appointment?
Annuities

If you answer "yes" to any of the following questions, please provide the name of payor, contract number, copy of the contract, the named beneficiary, most recent statement, etc.

Was the decedent receiving an annuity or pension at the time of his/her death (other than social security)?
Is anyone else entitled to receive payments under the annuity or pension?
Was the decedent a beneficiary or participant of any pension or profit-sharing plan at the time of his or her death?
Did the decedent have any IRA accounts?
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LIABILITIES OF THE DECEDENT

Debts of the decedent, mortgages, and liens were outstanding at the time of death. Provide the name and address of the creditor, account number, and amount.

Funeral expenses

(burial costs, payments to clergy, flowers, reception, etc.)

Administration expenses

(Executor's out-of-pocket expenses, accountant, etc.)

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PLEASE ALSO INCLUDE COPIES OF THE FOLLOWING ITEMS, IF AVAILABLE:

1. Certified copies of death certificate.

2. Copy of recorded deeds.

3. Copy of most recent tax bill showing assessed value.

4. Copy of the decedent's last income tax return.

5. Copy of any trust agreements.

6. Copy of any partnership agreements.

7. Copy of any real or personal property appraisals.

8. Copy of any gift tax returns.

9. Copy of personal property/excise tax bills.

10. Copy of promissory notes and amortization schedules.

11. Copy of bank and brokerage statements.

12. Copy of annuity contracts.

13. Copy of citizenship papers of spouse, if any.

14. Copy of all statements from life insurance companies.

15. Copy of the will.

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Address

33 Robinhood Dr
Etters, PA, 17319-9321, US

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