James H. Beauchamp
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ESTATE PLANNING WORKSHEET

PERSONAL INFORMATION :

Husband:
Full Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Residence Telephone: (____)___________________
Business Telephone: (____)___________________ Ext.____________
Birth date: __________________________________
Birthplace: __________________________________
SS#: ______________________________________
U.S. Citizen: _______
If Not, Which Country: ________________________
Marital Status: ___ Married ___Single ___Widowed ___Divorced

Wife:
Full Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Residence Telephone: (____)___________________
Business Telephone: (____)___________________ Ext.____________
Birth date: __________________________________
Birthplace: __________________________________
SS#: ______________________________________
U.S. Citizen: _______
If Not, Which Country: ________________________
Marital Status: ___ Married ___Single ___Widowed ___Divorced


FAMILY INFORMATION

Children From This Marriage:
(1) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________

(2) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________

(3) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________

Adopted Children:
(1) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________

PRIOR MARRIAGES

Husband’s Former Spouse: _______________________________________________________
Marriage was Severed by Death or Divorce (indicate which): _____________________________
Severance Date: __________________________________

Wife’s Former Spouse: _________________________________________________________
Marriage was Severed by Death or Divorce (indicate which): _____________________________
Severance Date: __________________________________

Children from this/these marriage(s): (Please indicate which marriage for each child):
(1) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________

(2) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Social Security No._____________________
Birth date: ____________________________


YOU NEED TO CHOOSE THE FOLLOWING REPRESENTATIVES

(Note: An executor and trustee can be the same person. In general, an executor will handle the many details at your death and a trustee may have ongoing money management responsibilities. Some people elect to have a spouse or close friend as executor and/or money manager or bank trust department as a trustee. It is wise to choose both primary and alternate representatives.)

EXECUTOR of Husband’s Estate:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

ALTERNATE:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

EXECUTOR of Wife’s Estate:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

ALTERNATE:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

TRUSTEE of Husband’s Estate:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

ALTERNATE:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

TRUSTEE of Wife’s Estate:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

ALTERNATE:
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

GUARDIAN of minor children in event of husband’s death
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

GUARDIAN of minor children in event of wife’s death
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

GUARDIAN of minor children in event of both husband and wife’s death
Name: _______________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip

DISTRIBUTION

Upon my death, I desire my estate to be distributed as follows:

Surviving Spouse: ___________%

Others:

(1) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

(2) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

Specific gifts to certain/special people:

(1) Name: ____________________________________________________________________
     Gift: ______________________________________________________________________

(2) Name: ____________________________________________________________________
     Gift: ______________________________________________________________________

(3) Name: ____________________________________________________________________
      Gift: ______________________________________________________________________

(4) Name: ____________________________________________________________________
      Gift: ______________________________________________________________________

Upon the death of the surviving spouse, the estate to be distributed is as follows:

(1) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

(2) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

(3) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

(4) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

(5) Name: ____________________________________________________________________
Address: _____________________________________________________________________
                  Street                                     City                            State                   Zip
Percent: ________________%

ASSETS:

Real Estate: (also include minerals): ________________________

Vehicles, Automobiles, Boats, etc: _________________________

Bank accounts, CD's, Checking, savings: ____________________

Life insurance: (name of insurance company, address of company, face amount, owner of policy,
beneficiary, policy number) _________________________________

Securities: (stocks, bonds, mutual funds) -- brokerage account number, owner of account, Series EE bonds, Series HH bonds, if securities owned in certificate form, certificate number, CUSIP number, number of shares, name and address of stock transfer agent, how ownership is currently
styled: ________________________________________

Money owed to you: (date of note, payor, amount, if secured bymortgage, book and page where recorded): _____________________

Royalties, patents, copyrights: _______________________________

Annuities: (same information as on life insurance; is it a tax deferred annuity?)

Registered animals: (all information dealing with the registrar, and the animal which is
registered): _______________________________

Member of investment club: (all information concerning club,
ownership): _______________________________________________

Assets held in trust for another: (such as realtor's trust account for escrowed
funds): ________________________________________

Small business interests: (proprietorships, corporations, partnerships, LLC's, limited
partnerships) __________________________________

Registered coin collections: ___________________________________

Retirement benefits: (IRAs, Roth IRAs, §401k plans, SEPs, TSAs, §403b plans, Keogh plans, profit sharing plans, pension plans, and any other type of retirement plan) __________________________

The above checklist ought to give you an idea of what sort of information is needed before a trust can be funded. Not all of the assets will be placed in the trust, but death beneficiary designation forms will have to be prepared.

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jim@jhbpc.com


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