Quickstart Inventory Assessment 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 Submit
