Farner & Perrin, LLP | Leaving a Lasting Legacy

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Wendy M. Farner
Diane V. Perrin

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Getting Started Form: Estate Planning Checklist (Single)

If you wish to submit your Estate Planning Checklist online, please complete the applicable fields and press "submit." Or if you prefer, feel free to print a PDF version of the applicable form to complete and bring it with you to your appointment.

First Name: Middle Initial: Last Name:

Nickname or Preferred Name:

Date of Birth:	Occupation:
Gender:
Are You a U.S. Citizen?	Resident of Texas since what year?
If not, of what country are you a citizen?

Street Address:

City:		State:
Zip Code:		County:
E-mail Address:

How do you prefer to receive drafts of documents?

Home Phone: - -

Work Phone: - -

Cell Phone: - -

Names of children, if any:

Children (indicate natural, adopted, step)	Date of Birth	Married?	Occupation/Special Considerations

Have you ever been married before?

If so, are there any divorce obligations at death, such as required life insurance to pay to ex-spouse or children?

If so, please explain:

Are you a party to a lawsuit?
Do you currently anticipate being a party to a lawsuit?
Does any beneficiary of your estate receive any government benefit payments (specify SSI or SSD) or have any problems or needs requiring special treatment in your Will, including concerns related to health, marriage, drug or alcohol abuse?

If yes, please describe:

Financial Information:

Life Insurance (Show face value; indicate term insurance with “T”)
Residence (Show any mortgage at debts below)
Other Texas Real Property (Improved or unimproved)
Other Real Property, not in Texas (Separately list any real property/minerals in other states)
Publicly-traded Stocks, Bonds and Mutual Funds (Do not list IRAs/qualified plans/annuities here)
Closely-held Stocks (Mark “S” if S corp.)
Partnership Interests (Mark “GP” for general partner, “LP” for limited partner interest)
Cash (Checking, savings, CDs)
Notes or Accounts Receivable from any child/ren
IRAs, Qualified Plans (401k, profit sharing, pension, etc.) (Mark “IRA” unless employer plan)
Non-Qualified Employee Benefits (Deferred compensation, stock options, etc.)
Annuities (issued by insurance company)
Collections, Boats, Jewelry, Etc.
Other Assets
Trusts (of which you are a beneficiary)
Expected Inheritances
Debts
Total Value of Estate

Describe in your own words how you want your property to pass:

Describe who you wish to serve in the following capacities:

	Executor
	Trustee of any Trusts for Your Children:
	Guardian for any minor Children:
	Agent of Your Finanical Power of Attorney:
	Agent of Your Medical Power of Attorney:
	Party(ies) allowed to obtain your private medical records:

Do you desire a "living will" (a document stating whether or not you wish to be kept alive by extraordinary measures)? NOTE: Your medical agent may make life/death decisions if you are incapacitated and you do not sign a living Will.

Who do you want to send this form to?

Diane Perrin Wendy Farner