Estate

Planning Informa1on

Name: Date:

This ques/onnaire has been designed to help you, not frustrate you. Please complete it as best you can and bring it with you to your rst mee/ng at my oce. Do not spend an inordinate amount of /me on it, and do not be concerned if you are unable to provide all the nancial informa/on requested on the form. All informa/on you provide on this ques/onnaire will be held in strict condence.

One Boars Head Place Suite 101 Charlottesville Virginia (434) 2939836 [email protected]

I. CLIENT CONTACT INFORMATION

Home Address: Street City Zip

State

Is your home located in the city or the county? How did you select my rm as your legal counsel?

Would you prefer to receive your rst document draJs by email or as paper copies in the mail? Mailing address (if dierent from home) Client 1 Full Legal Name Formal Name* Date of Birth Preferred Phone Occupa/on Employer

Client 2

Email Address

How long have you been together as a couple?

*Your name as you would like it to appear on your estate planning documents.

II. YOUR CHILDREN

Formal Name

Date of Birth Parent1

City & State of Residence

J (Joint); C1 (Client 1); C2 (Client 2)

III. YOUR FINANCIAL SUMMARY

Please use es/mated current fair market values.

ASSETS Primary Residence Second Residence** Other Real Estate** Cash & Equivalents 1 Marketable Securi/es 2 Partnerships & LLC 3 Re/rement Accounts 4 Annui/es Vehicles Other Valuable Tangibles 5 Total Death Benet from all Life Insurance 6 Other Valuable Assets 7 TOTAL ASSETS Es/mated Inheritance LIABILITIES Mortgage, Residence Mortgage, 2nd Residence Other Debts TOTAL DEBTS NET WORTH

Jointly Titled

Client 1's Name

Client 2's Name

*Please indicate loca/on(s) of your second residence or other real estate on last page of ques/onnaire.

Checking, savings, money market accounts, cer/cates of deposit, etc. 2 Stocks, bonds, mutual funds, real estate investment trusts, and limited partnerships that are publicly traded. 3 Partnerships and LLC interests which are not publicly traded. 4 Re/rement benets provided through an employer such as a 401-k, IRAs, TIAA-CREF, etc. 5 Furnishings, jewelry, furs, and collec/ons, e.g., a coin or art collec/on. 6 Please insert the total insurance proceeds from the Death Benet line of Sec/on IV, next page. 7 Any other valuable assets not listed above.

IV. YOUR LIFE INSURANCE

Insured Owner 2 Company Type 3 Beneciary 4 Death Benet Cash Value
1
1 2

Policy 1

Policy 2

Policy 3

Policy 4

H (Husband); W (Wife) H (Husband); W (Wife) 3 P (Permanent; T (Term); G (Group term) 4 H (Husband); W (Wife)

V. YOUR PROFESSIONAL ADVISORS Accountant & Firm Investment/Financial Advisor Life Insurance Agent

VI. THE KEY PEOPLE IN YOUR ESTATE PLAN

When we meet, we will discuss the appropriate choices for executor, trustee, and other agents under your

estate planning documents. Your ul/mate selec/ons will be among the most cri/cal decisions you will make in your estate planning. We believe a helpful star/ng point for our discussion will be your ini/al inclina/ons as to the persons who might ll these roles. Spouses do not necessarily have to choose the same persons. In those situa/ons where you wish to make dierent choices, sucient space has been leJ in the table below for this purpose. Please include a current address for the persons you select.

1st Choice Executor(s) 1 Trustee(s) 2 Agent(s) under Financial Power of Alorney 3 Agent(s) under Medical Power of Alorney 4 Guardian(s) for Minor Children 5

2nd Choice

Someone to selle your estate upon your death. This can be your spouse, adult children, other family members, trusted friends or a professional executor, such as an alorney or a bank. 2 Someone to administer any trusts you may establish during your life or upon your death. This can be your spouse, adult children, other family members trusted friends or a professional trustee, such as a an alorney or bank. 3 Someone to handle your nancial and administra/ve aairs for you if you become incapacitated. 4 Someone to make health and medical treatment decisions for you if you become incapacitated. 5 Someone to raise your children if both Husband and Wife die while any child is under 18.
1

VII. QUESTIONS FOR YOU

Ques1on Has either Husband or Wife been previously married? 1 Has either Husband or Wife signed a pre-marital or post-marital agreement? Is either Husband or Wife ci/zens of a country other than the United States? Are any of your children adopted? Do you have a deceased child? Do you have any beneciaries with physical or mental disabili/es? Are they receiving government assistance (ex.: Medicare, Medicaid, SSI, etc.) Do you own assets jointly with any person other than your spouse/partner? 2 Do you own an interest in a closely held business? 3 Are you the beneciary of a trust created by someone else? Do you have any exis/ng wills, trusts, or other estate planning documents? Have you ever lived in a community property state? Do you own real property outside Virginia? Have you made giJs in excess of $10,000 in value to any one person in any one year? 4 Have you led a Federal GiJ Tax return? Do you an/cipate any signicant change in assets, liabili/es or income in coming years? 5 Are you concerned about the safety of any adult beneciarys inheritance due to the beneciarys serious marital or nancial instability? Do you own any insurance on the life of another person? Is there any person who is nancially dependent upon you other than minor children? Is there any addi/onal informa/on or concern about which you think your alorney should know? If so, please explain on the following page.

Yes

No

1 If yes, please indicate on the following page how the marriage ended, whether any children were born of the marriage, and if the marriage ended by divorce, whether there are any current obliga/ons to pay child support, alimony or to maintain life insurance. 2 If yes, please describe on the following page the joint ownership, including the name of the joint owner(s) of the asset, and the percentage owned. 3 If yes, please specify on the following page what type of business (e.g., C Corpora/on, S Corpora/on, Limited Liability Company, etc.), and the percentage owned. 4 If yes, please itemize all such giJs on the following page. 5 If yes, please describe on the following page.

VIII. YOUR COMMENTS

NOTES/QUESTIONS:

Billing Prac1ces
Whenever it is prac/cal to do so, we prepare estate planning documents for a xed fee, as opposed to hourly billing. We use a schedule serng forth the range of our fees for estate planning services. These fees reect: (i) the value of the services provided. (ii) the level of exper/se required and (iii) the an/cipated /me and eort involved on our part. We are usually able to quote a xed fee at the conclusion of our rst mee/ng. As part of the estate planning process, we will generally:
1. Review and discuss your present estate planning documents, personal nancial statement, re/rement 2. 3. 4.

5.

death benets, and life insurance policies. Recommend and prepare a new or altered estate plan that typically includes a last will and testament, a revocable trust agreement, a durable nancial power of alorney, and an advance medical direc/ve. Supervise and par/cipate in the execu/on of new estate planning documents. Assist with beneciary designa/on changes appropriate to the new estate plan and recommend changes in asset ownership (as may be appropriate to the new estate plan and recommend changes in asset ownership (as may be appropriate). If the estate planning documents are not executed within six months aJer the delivery of the draJs, your le may be transferred to inac/ve status. In that situa/on, we reserve the /ght to bill the agreed- upon fee and we will not send out any further reminders about comple/ng the estate planning process. Of course, you may re-ac/vate the estate [planning project later on and we will be glad to see it through to comple/on.

Thank you for considering April R. Fletcher, PLC. We look forward to working with you and helping you achieve family harmony in your estate planning.