Quickstart Inventory Assessment

Client’s Signature Name *

Client’s Email *

Primary Phone Number *

Also known as

Preferred Name

Date of Birth

Social Security Number

Are you a U.S. Citizen

Yes

No

Home Address *

City *

State *

Zip Code *

Work Address

Work City

Work State

Work Zip Code

Are you

Married

Divorced

Single

Cohabitating

Spouse Signature Name

Spouse Email Address

Spouse Phone Number

Spouse Also Known As

Spouse Preferred Name

Spouse Date of Birth

Spouse Social Security Number

Is Spouse a U.S. Citizen

Yes

No

Spouse Home Address

Spouse City

Spouse State

Spouse Zip Code

Spouse Home Phone

Spouse Mobile Phone

Spouse Work Phone

Spouse Occupation

Spouse Employer

Spouse Work Address

Spouse Work City

Spouse Work State

Spouse Work Zip Code

1) Dependent Name

1) Date of Birth

1) Relationship

2) Dependent Name

2) Date of Birth

2) Relationship

3) Dependent Name

3) Date of Birth

3) Relationship

4) Dependent Name

4) Date of Birth

4) Relationship

5) Dependent Name

5) Date of Birth

5) Relationship

Accountant

Accountant Phone Number

Investment Advisor

Advisor Phone Number

Life Insurance Agent

Agent Phone Number

Your Planning Objectives: Preserve and Maximize Assets (Husband)

By minimizing taxes during your life (income taxes, capital gains taxes, estate taxes on inheritances you expect to receive), including estate taxes upon your death (up to 55% of your assets and life insurance benefits).

By ensuring assets have maximum FDIC insurance protection.

By reducing estate administration costs through probate avoidance.

Avoid or limit MediCal claims on your assets should you require long-term care.

Ensure that a special needs beneficiary has assets that are protected from government seizure while retaining eligibility for needed services.

Ensure that your family has enough life insurance to provide a comfortable lifestyle no matter what.

By ensuring that your assets are passed to your descendants and not given away to outsiders, such as spouses, creditors or the government.

Please identify the reasons you are considering planning or areas you would like to learn more about. Select as many as you wish:

HUSBAND: Do you have a will, trust, or other estate planning document? Please furnish copies of these documents.

Yes

No

WIFE: Do you have a will, trust, or other estate planning document? Please furnish copies of these documents.

Yes

No

HUSBAND: Are you making payments pursuant to a divorce or property settlement order? Please furnish a copy.

Yes

No

WIFE: Are you making payments pursuant to a divorce or property settlement order? Please furnish a copy.

Yes

No

HUSBAND: Do you or any of your children or other beneficiaries have disabilities, serious health problems or other special needs? If yes, please describe below.

Yes

No

WIFE: Do you or any of your children or other beneficiaries have disabilities, serious health problems or other special needs? If yes, please describe below.

Yes

No

HUSBAND: Do you own a business?

Yes

No

WIFE: Do you own a business?

Yes

No

HUSBAND: Do you own a long-term care (nursing home) insurance policy?

Yes

No

WIFE: Do you own a long-term care (nursing home) insurance policy?

Yes

No

HUSBAND: Do you own any property that is not community property?

Yes

No

WIFE: Do you own any property that is not community property?

Yes

No

HUSBAND: Have you (or your spouse) ever filed federal or state gift tax returns? Please furnish copies of these returns.

Yes

No

WIFE: Have you (or your spouse) ever filed federal or state gift tax returns? Please furnish copies of these returns.

Yes

No

HUSBAND: Do you support any charitable organizations now that you wish to make provisions for at the time of your death? If so, please explain below.

Yes

No

WIFE: Do you support any charitable organizations now that you wish to make provisions for at the time of your death? If so, please explain below.

Yes

No

HUSBAND: Are you (or your spouse) currently the beneficiary of anyone else’s trust.? If so, please explain below.

Yes

No

WIFE: Are you (or your spouse) currently the beneficiary of anyone else’s trust.? If so, please explain below.

Yes

No

Additional information from above or anything else you want to tell me:

HUSBAND’S Monthly Income

JOINT Monthly Income

WIFE’S Monthly Income

HUSBAND’S Social Security Income

JOINT Social Security Income

WIFE’S Social Security Income

HUSBAND’S Monthly Pension

JOINT Monthly Pension

WIFE’S Monthly Pension

HUSBAND’S Other Monthly Income

JOINT Other Monthly Income

WIFE’S Other Monthly Income

1) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

2) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

3) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

4) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

4) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

5) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

6) Real Property: General description and/or address

Owner?

Yes

No

Market Value

Equity

1) Personal Property Description

List separately only major personal effects, such as jewelry, collections, and all other valuable non-business personal property (indicate type below and give a lump sum value for miscellaneous, less valuable items).

Owner?

Yes

No

Value

2) Personal Property Description

Owner?

Yes

No

Value

3) Personal Property Description

Owner?

Yes

No

Value

4) Personal Property Description

Owner?

Yes

No

Value

5) Personal Property Description

Owner?

Yes

No

Value

6) Personal Property Description

Owner?

Yes

No

Value

Retirement Accounts

Type: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K). Additional Information: Describe the type of plan, the plan name, the current value of the plan, and any other pertinent information.

↳ Total

Business Interests

Type: General and Limited Partnerships, Sole Proprietorships, privately owned corporations, professional corporations, oil interests, farm and ranch interests. Additional Information: Give a description of the interests, who has the interest, your ownership in the interests, and the estimated value of the interests.

↳ Total

1) Money Owed to You. Name of Debtor

Date of Note

Date of Maturity

Owed to

Current Balance

2) Money Owed to You. Name of Debtor

Date of Note

Date of Maturity

Owed to

Current Balance

3) Money Owed to You. Name of Debtor

Date of Note

Date of Maturity

Owed to

Current Balance

4) Money Owed to You. Name of Debtor

Date of Note

Date of Maturity

Owed to

Current Balance

Anticipated inheritance, gift, or lawsuit judgment

Gifts or inheritances that you expect to receive at some time in the future; or moneys that you anticipate receiving through a judgment in a lawsuit. Describe in appropriate detail.

↳ Total Estimated Value

Long-Term Guardian for Minor Children

If you have any children under the age of 18, list in order of preference who would raise them and love them in the manner as close as possible to the way you would for the long-term. Please enter name, address, phone number and relationship.

Short-Term Guardian for Minor Children

If you have any children under the age of 18, list in order of preference who would be able to be immediately available to them (within 20 minutes) if you could not be located. Please enter name, address, phone number and relationship.

Guardian for Pets

Death Trustee

After both of your deaths, who do you want making decisions regarding the management and distribution of your assets to your beneficiaries? Please enter name, address, phone number and relationship.

Health Care Decision Makers

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment? Husband’s Agent Please enter name, address, phone number and relationship.

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

No

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

No

Wife’s Agent

Please enter name, address, phone number and relationship.

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

No

Do you want to provide that the moment of your death not be unnecessarily prolonged by artificial means or measures?

Yes

No