Wenzel & Wenzel, PLLC

166 Branner Ave, Ste A
Waynesville, NC 28786

828-452-9099

Estate Planning Client Worksheet for an Individual

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out the form to the best of your ability. Please note that we do not schedule consultations until we have received your worksheet.

Please also review the attachments, regarding our process, pricing, and disclosures.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Please also review the attachments, which include our process, scheduling, policies, pricing, etc.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

General Documentation Request

Please provide copies of the following documents. If you have digital copies, you can attach them at the end of this worksheet. Otherwise, you can drop off copies to our office prior to your consultation.

1. Copies of all deeds to real estate owned by you (other than Haywood County, NC).

2. Copies of any stock or bond certificates for stocks not owned in a brokerage account (such as Computershares, etc.)
3. Is there a Prenuptial or Postnuptial Agreement, Divorce Decree, or Property Settlement Agreement under which continued obligations exist (child or spousal support, maintain life insurance policy, etc.)? If yes, please provide a copy
4. Copies of any existing planning documents, including wills, trusts, powers of attorney, health care directives, etc.

PART I - Personal Information

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Name on Photo Identification:

Also known as:

(other names used to title property and accounts)

Preferred Name for Signing Documents:

Marital Status

If Married: If yes, STOP here, and contact us. We have a different worksheet that asks questions about your spouse.

Yes

If Divorced:

Yes

If Widowed:

Yes

Are either of your parents still living?

Yes

Are any of your grandparents still living?

Yes

CHILDREN AND OTHER FAMILY MEMBERS AND BENEFICIARIES

For each child or other family member, please select "Yes" and fill out the following information.

Please list all children, even if you do not want to leave them anything. Further, please also include any other beneficiaries you wish to name.

Child or Other Family Member or Beneficiary #1:

Yes

Child or Other Family Member or Beneficiary #2:

Yes

Child or Other Family Member or Beneficiary #3:

Yes

Child or Other Family Member or Beneficiary #4:

Yes

Child or Other Family Member or Beneficiary #5:

Yes

YOUR CONCERNS

Please let us know if you have any of the following concerns

Disinheriting a family member.

Yes

Providing for charities at the time of death.

Yes

Protecting beneficiaries' inheritance from lawsuits, divorces, or their creditors.

Yes

Plan for a child with disabilities or special needs.

Yes

Other Concerns:

(Please list below)

IMPORTANT FAMILY QUESTIONS

(Please check “Yes” or “No” for your answer)

Are you making payments pursuant to a divorce or property settlement order?

Yes

Have you ever filed federal or state gift tax returns?

Yes

Have you completed previous will, trust, or estate planning?

Yes

Are you currently the beneficiary of anyone else’s trust?

Yes

Additional Information:

PART II - Asset Information

Instructions for completing the Asset Information section:

General Headings

This Asset Information section helps you list all the assets you own. If you do not own assets under a particular heading, just leave that section blank.

“Owner” of Assets

How you own your assets is extremely important for purposes of properly designing and implementing your estate plan. For each asset, please indicate how the asset is titled. Please list owners' names and how it is owned.

Ownership

Please list how each asset is owned:

- Client

- Spouse

- Client and Spouse, Joint

- Client and Spouse, Joint with Right of Survivorship

- Client and someone else, Joint

- Client and someone else, Joint with Right of Survivorship

Real Property

TYPE: Any interest in real estate including your family residence, vacation home, timeshare, vacant land, etc.

Real Property #1:

Yes

Real Property #2:

Yes

Real Property #3:

Yes

Real Property #4:

Yes

Real Property #5:

Yes

Automobiles, Boats, and RVs

TYPE: For each motor vehicle, boat, RV, etc. please list the following: description and names on title:

Vehicle #1:

Yes

Vehicle #2:

Yes

Vehicle #3:

Yes

Bank Accounts

TYPE: Checking Account “CA”, Savings Account “SA”, Certificates of Deposit “CD”, Money Market “MM” (indicate type below). Do not include IRAs or 401(k)s here

Bank Account #1:

Yes

Bank Accounts #2:

Yes

Bank Accounts #3:

Yes

Stocks and Bonds

TYPE: List any and all stocks and bonds you own. If held in a brokerage account, lump them together under each account. (indicate type below)

Stocks and Bonds #1:

Yes

Stocks and Bonds #2:

Yes

Stocks and Bonds #3:

Yes

Stocks and Bonds #4:

Yes

Life Insurance Policies and Annuities

Please indicate the name of the insurance company, who owns the policy, and who the beneficiaries are

Life Insurance or Annuity #1:

Yes

Life Insurance or Annuity #2:

Yes

Life Insurance or Annuity #3:

Yes

Life Insurance or Annuity #4:

Yes

Retirement Plans

TYPE: Pension (P), Profit Sharing (PS), H.R. 10, IRA, SEP, 401(K).

ADDITIONAL INFORMATION: List the name of the company, type of plan, and the beneficiaries.

Retirement Account #1:

Yes

Retirement Account #2:

Yes

Retirement Account #3:

Yes

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 your ownership interest.

Business Interests:

Money Owed To You

TYPE: Mortgages or promissory notes payable to you, or other moneys owed to you.

Money Owed To You #1:

Yes

Money Owed To You #2:

Yes

Anticipated Inheritance, Gift, or Lawsuit Judgment

TYPE: 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.

Anticipated Inheritance, Gift, or Lawsuit Judgment:

Other Assets

TYPE: Other property is any property that you have that does not fit into any listed category.

Other Asset #1:

Yes

Other Asset #2:

Yes

Summary of Values

For any joint property or asset, only include your portion.

CLIENT - Total:

PART III - Design Information

PERSONS TO ACT FOR YOU:

Guardian for Minor Children

If you have any children under the age of 18, list in order of preference who you wish to be guardian.

Guardian for Minor Children:

Yes

Alternate Guardian for Minor Children:

Yes

CLIENT - Executor/Trustee

After your death, who do you want carrying out your instructions, for distribution to and, if desired, management of property for your beneficiaries?

Executor/Trustee #1:

Yes

Executor/Trustee #2:

Yes

Executor/Trustee #3:

Yes

Executor/Trustee #4:

Yes

CLIENT - Financial Power of Attorney/Trustee if Incapacitated

If you were unable to make financial decisions for yourself, who would you want to make financial decisions for you?

Agent #1:

Yes

Agent #2:

Yes

Agent #3:

Yes

CLIENT - Health Care Power of Attorney

If you were unable to make decisions for yourself, who would you want to make decisions for you with regard to your medical treatment? This may be short term (an accident, stroke, etc), or this may be long term (dementia, etc.), or this may be at the end of life stage.

Health Care Agent #1:

Yes

Health Care Agent #2:

Yes

Health Care Agent #3:

Yes

Health Care Agent #4:

Yes

Do you have a primary care physician?

Yes

Do you want to authorize your Health Care Agent to take whatever steps are necessary to keep you in a personal residence rather than nursing home?

Yes

Do you want to limit your Health Care Agent's authority regarding any of the following? 1. General health care decisions 2. Mental health decisions 3. Authorizing an autopsy if your agent thought it necessary 4. Authorizing organ donation 5. Directing the disposition of your remains

Yes

CLIENT - Living Will

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

Yes

SPECIFIC GIFTS

List any specific gifts of real estate or cash gifts you wish to make to either individuals or charities. Indicate whether these gifts are to be made even if the other spouse is alive.

Specific Gift #1:

Yes

Specific Gift #2:

Yes

Specific Gift #3:

Yes

Specific Gift #4:

Yes

Specific Gift #5:

Yes

Specific Gift #6:

Yes

DIVISION OF PROPERTY UPON DEATH

DIVISION OF PROPERTY UPON DEATH OF SECOND SPOUSE TO DIE:

DIVIDE EQUALLY BETWEEN MY CHILDREN AND THE DESCENDANTS OF ANY DECEASED CHILDREN

DIVIDE AMONG NAMED INDIVIDUALS and/or CHARITIES:

Other:

HOW AND WHEN TO DISTRIBUTE MY PROPERTY

 DISTRIBUTE OUTRIGHT TO OUR BENEFICIARIES: Provides no protection from creditors, spouses, or from themselves.

 HOLD IN TRUST FOR BENEFICIARIES AND DISTRIBUTE OVER TIME: You determine how long the property is to remain in trust. During the period of time the property is held in trust, we can specify that it can be used for the beneficiary's needs, such as health, education, maintenance, and support.

You may provide for a staggered distribution of principal. For example:. 1/3 at age 25, 1/2 of balance at age 30, and then remaining balance at age 40.

HOW AND WHEN TO DISTRIBUTE MY PROPERTY:

DISTRIBUTE OUTRIGHT TO MY BENEFICIARIES

IN TRUST OVER TIME (Will discuss options in detail with Attorney)

If a beneficiary were to predecease you or complete distribution of their share, would you want the beneficiary's share to pass to his or her children?

Yes

BACKUP BENEFICIARY

Who do you want to receive your property in the remote event that no one listed above is alive to receive your property?

In the remote event no one listed above is alive to receive my property I want my property distributed as follows:

 To my heirs-at-law.
 To the following named individuals and/or charities:

REMOTE CONTINGENT BENEFICIARY:

To my heirs-at-law.

To the following named individuals and/or charities:

OTHER ITEMS TO INCLUDE OR DISCUSS

Obviously your estate plan should address all your hopes, fears, and wishes. Please list any other items you want included or want to discuss:

THANK YOU

When you are finished, please click the "Submit" button.