ESTATE PLANNING WORKSHEET

USING THIS ORGANIZER WILL ASSIST US IN DESIGNING AN ESTATE

PLAN THAT MEETS YOUR GOALS.

ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.

KRASA LAW  704-D Forest Avenue, Pacific Grove, California 93950

Phone: 831- 920-0205  Fax: (831) 274-8224  [email protected]
 PERSONAL INFORMATION
Husband’s Legal Name________________________________________________________________________________________
(name most often used to title property and accounts)
Also Known As _____________________________________________________________________________________________
(other names used to title property and accounts)

Prefer to be called Birth date SS# __________________ US Citizen? __

Home Address City State Zip ____________
Home Telephone County of Residence Business Telephone __________________
Employer Position _____________________________________
Business Address City State Zip _________
E-mail Address  It is okay to communicate with me via my E-mail address.
Date of Marriage
Wife’s Legal Name __________________________________________________________________________________________
(name most often used to title property and accounts)
Also Known As _____________________________________________________________________________________________
(other names used to title property and accounts)

Prefer to be called Birth date SS# __________________ US Citizen? __

Home Address City State Zip ____________
Home Telephone County of Residence Business Telephone __________________
Employer Position _____________________________________
Business Address City State Zip _________
E-mail Address  It is okay to communicate with me via my E-mail address.

CHILDREN AND/OR OTHER FAMILY MEMBERS

(Use full legal name. Use “JT” if both spouses are the parents, “H” if husband is the parent, “W” if wife is the parent, “S” if a single
parent.)
Name Birth date Parent or Relationship
_________________
Comments:
_________________
Comments:
_________________
Comments:
_________________
Comments:
_________________
Comments:
_________________
Comments:
_________________
Comments:
 ADVISORS Page 3

Name Telephone
Personal Attorney _____________________
Accountant _____________________
Financial Advisor
Life Insurance Agent _____________________

YOUR CONCERNS
Please rate the following as to how important they are to you:
(H high concern, S some concerned, L low concern, N/A no concern or not applicable)

Description Level of Concern

Husband Wife
Desire to get affairs in order and create a comprehensive plan to manage affairs in case of
death or disability.
Providing for and protecting a spouse.
Providing for and protecting children.
Providing for and protecting grandchildren.
Disinheriting a family member.
Providing for charities at the time of death.
Plan for the transfer and survival of a family business.
Avoiding or reducing your estate taxes.
Avoiding probate.
Reduce administration costs at time of your death.
Avoiding a conservatorship (“living probate”) in case of a disability.
Avoiding will contests or other disputes upon death.
Protecting assets from lawsuits or creditors.
Preserving the privacy of affairs in case of disability or at time of death from business
competitors, predators, dishonest persons and curiosity seekers.
Plan for a child with disabilities or special needs, such as medical or learning disabilities.
Protecting children’s inheritance from the possibility of failed marriages.
Protect children’s inheritance in the event of a surviving spouse’s remarriage.
Provide that your death shall not be unnecessarily prolonged by artificial means or
measures.
Other Concerns (Please list below):
 IMPORTANT FAMILY QUESTIONS Page 4

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

Are you (or your spouse) receiving Social Security, disability, or other governmental
benefits? Describe ____________________________________________________

Are you (or your spouse) making payments pursuant to a divorce or property settlement
order? Please furnish a copy

If married have you and your spouse signed a pre- or post-marriage contract? Please
furnish a copy

Have you (or your spouse) been widowed? If a federal estate tax return or a state death
tax return was filed, please furnish a copy

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

Have (you or your spouse) completed previous will, trust, or estate planning? Please
furnish copies of these documents

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.

Are there any other charitable organizations you wish to make provisions for at the time
of your death? If so, please explain below.

If married, have you lived in any of the following states while married to each other?
Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or
Wisconsin

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

Do any of your children have special educational, medical, or physical needs?

Do any of your children receive governmental support or benefits?

Do you provide primary or other major financial support to adult children or others?

ADDITIONAL RELEVANT INFORMATION

 Page 5

PROPERTY INFORMATION

INSTRUCTIONS FOR COMPLETING

THE PROPERTY INFORMATION CHECKLIST

General Headings This Property Information checklist is designed to help you list all the
property you own and what it is worth. If you do not own property under
a particular heading, just leave that section blank. Under certain headings
you may own more property than can be listed on this checklist. If so, use
extra sheets of paper to list your additional property.

“Owner” of Property How you own your property is extremely important for purposes of
properly designing and implementing your estate plan. For each property
please indicate how the property is titled. When doing so, please use the
following abbreviations:

Owner of Property Use

If married, Husband’s name alone, with no other person H

If married, Wife’s name alone, with no other person W

If married, Joint Tenancy with spouse JTS

Joint Tenancy with someone other than a spouse, i.e. a JTO

child, parent, etc.

If you cannot determine how the property is owned ?

 Page 6

CHECKING ACCOUNTS:

Please provide the Local address information for each institution.

NAME AND LOCAL ADDRESS OF INSTITUTION ACCOUNT NUMBER BALANCE OWNER(S) OFFICE USE

SAVINGS ACCOUNTS:

Please provide the Local address information for each institution.

NAME AND LOCAL ADDRESS OF INSTITUTION ACCOUNT NUMBER BALANCE OWNER(S) OFFICE USE

$
MONEY MARKET ACCOUNTS: Page 7

NAME AND LOCAL ADDRESS OF INSTITUTION ACCOUNT NUMBER BALANCE OWNER(S) OFFICE USE

CERTIFICATES OF DEPOSIT:

NAME AND LOCAL ADDRESS OF INSTITUTION ACCOUNT NUMBER BALANCE OWNER(S) OFFICE USE

$
SAFE DEPOSIT BOXES: Page 8

NAME AND LOCAL ADDRESS OF INSTITUTION BOX NUMBER OWNER(S) OFFICE USE

TAXABLE BROKERAGE ACCOUNTS:

DO NOT LIST RETIREMENT ACCOUNTS HERE – PLEASE LIST THEM IN THE RETIREMENT
PLAN SECTION
Please list taxable accounts with brokerage firms that hold stock certificates, bonds, mutual funds, money market accounts and CDs for
you. Please provide complete address information for the brokerage firm.

NAME AND ADDRESS OF BROKERAGE ACCOUNT NUMBER BALANCE OWNER(S) OFFICE USE

$
STOCKS - INDIVIDUAL SHARE CERTIFICATES: Page 9
DO NOT LIST STOCKS THAT ARE IN A BROKERAGE OR RETIREMENT ACCCOUNT

Please list all stock in publicly-traded corporations in which you hold the actual stock certificates (this includes stock traded on an
exchange or over the counter).

NOTE: Stock owned in family or non-publicly-traded companies should be listed under the Business Interests section.

NAME OF STOCK AND ADDRESS FOR NOTICE CERTIFICATE NUMBER FAIR MARKET VALUE OWNER(S) OFFICE USE
$
TYPE OF STOCK: NUMBER OF SHARES:

$
TYPE OF STOCK: NUMBER OF SHARES:

$
TYPE OF STOCK: NUMBER OF SHARES:
________________________________

DIVIDEND REINVESTMENT:
DO NOT LIST ACCOUNTS THAT ARE IN A BROKERAGE OR RETIREMENT ACCOUNT

COMPANY NAME AND ADDRESS ACCOUNT NUMBER FAIR MARKET VALUE OWNER(S) OFFICE USE

$
 Page 10

MUTUAL FUNDS HELD SEPARATELY:

DO NOT LIST MUTUAL FUNDS THAT ARE IN BROKERAGE OR RETIREMENT ACCOUNTS

NAME OF FUND AND ADDRESS FOR NOTICE ACCOUNT NUMBER FAIR MARKET VALUE OWNER(S) OFFICE USE

BONDS (CORPORATE AND MUNICIPAL):

NAME OF BOND AND ADDRESS FOR NOTICE ACCOUNT NUMBER FACE VALUE OWNER(S) OFFICE USE

U.S. SAVINGS BONDS:

TYPE OF BOND ISSUE DATE SERIAL NUMBER FACE VALUE OWNER(S) OFFICE USE

$
$
$
$
$
$
$
$
 Page 11

U. S. TREASURY DIRECT:
ACCOUNT NAME ACCOUNT NUMBER FACE VALUE OWNER(S) OFFICE USE

$
$
$

LIMITED PARTNERSHIPS:

PARTNERSHIP NAME AND ADDRESS GENERAL PARTNER LIMITED PARTNER VALUE OWNER(S) OFFICE USE

% % $

% % $

GENERAL PARTNERSHIPS:

PARTNERSHIP NAME AND ADDRESS GENERAL PARTNER VALUE OWNER(S) OFFICE USE

$
 Page 12

LIMITED LIABILITY COMPANIES:

LLC NAME AND ADDRESS OWNERSHIP INTEREST VALUE OWNER(S) OFFICE USE

CORPORATE BUSINESS INTERESTS:

COMPANY NAME AND ADDRESS NUMBER PERCENTAGE BUY/SELL VALUE OWNER(S) OFFICE USE
OF SHARES OWNERSHIP

% $

% $

SOLE PROPRIETORSHIPS:

NAME OF BUSINESS DESCRIPTION OF BUSINESS VALUE OWNER(S) OFFICE USE

$
$
REAL PROPERTY INTERESTS: Page 13

ADDRESS AND/OR GENERAL DESCRIPTION LOANS FAIR MARKET OWNER(S) OFFICE USE
VALUE
$ $

$ $

$ $

$ $

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR EACH REAL PROPERTY:

POLICY NUMBER COMPANY NAME AND ADDRESS AGENT NAME OFFICE USE

TITLE INSURANCE

HOMEOWNER’S INSURANCE

MORTGAGE COMPANY
 Page 14

OIL AND GAS INTERESTS:

DESCRIPTION, AND OIL/GAS LESSEE NAME AND ADDRESS ESTIMATED VALUE OWNER(S) OFFICE USE
$

MORTGAGES AND DEEDS OF TRUST:

DO NOT LIST MORTGAGES THAT ARE LIABILITIES; ONLY LIST MORTGAGES THAT ARE ASSETS

NAME AND ADDRESS OF DEBTOR DATE OF NOTE CURRENT BALANCE OWED TO OFFICE USE
OWED

$
$
$

LEASES:

ADDRESS OR DESCRIPTION OF PROPERTY NAME AND ADDRESS OF LESSEE ANNUAL RENTS OWNER(S) OFFICE USE

$
 Page 15

TIME SHARES/CO-OPS:

PROPERTY NAME AND ADDRESS DEVELOPMENT OWNER(S) VALUE OWNER(S) OFFICE USE

NOTES RECEIVABLE:
NAME AND ADDRESS OF DEBTOR DATE OF NOTE NOTE AMOUNT OWNER(S) OFFICE USE

LIFE INSURANCE:

PLEASE REQUEST A COPY OF THE CURRENT BENEFICIARY DESIGNATIONS AND A BLANK CHANGE OF
BENEFICIARY FORM FOR EACH ACCOUNT.

COMPANY NAME AND ADDRESS TYPE FACE CASH BENEFICIARIES INSURED OWNER OFFICE USE
AMOUNT VALUE
$ $ 1ry
2ry
POLICY NUMBER:
$ $ 1ry
2ry
POLICY NUMBER:
$ $ 1ry
2ry
POLICY NUMBER:
 Page 16

ANNUITIES:

PLEASE REQUEST A COPY OF THE CURRENT BENEFICIARY DESIGNATIONS AND A BLANK CHANGE OF
BENEFICIARY FORM FOR EACH ACCOUNT.

COMPANY NAME AND ADDRESS TYPE ANNUITY BENEFICIARIES OWNER/ OFFICE USE
AMOUNT ANNUITANT
$ LIFETIME:
DEATH:
CONTRACT NUMBER:

$ LIFETIME:
DEATH:
CONTRACT NUMBER:

INVESTMENT RETIREMENT ACCOUNTS (IRAS):

PLEASE REQUEST A COPY OF THE CURRENT BENEFICIARY DESIGNATIONS AND A BLANK CHANGE OF
BENEFICIARY FORM FOR EACH ACCOUNT.

COMPANY NAME AND ADDRESS FOR NOTICE ACCOUNT NUMBER & DEATH BENEFICIARY VALUE OWNER(S) OFFICE USE

$
 Page 17

QUALIFIED PLANS (PENSION PLANS):

PLEASE REQUEST A COPY OF THE CURRENT BENEFICIARY DESIGNATIONS AND A BLANK CHANGE OF
BENEFICIARY FORM FOR EACH ACCOUNT.

COMPANY NAME AND ADDRESS TYPE % VESTED DEATH BENEFICIARY VALUE OWNER(S) OFFICE USE

% $
Account #: __________________

% $
Account #: __________________

INTELLECTUAL PROPERTY INTERESTS:

Please list all REGISTERED copyright, trademark, patent and royalty interests. If you have not registered any of these interests, please
see the “Informational Items” section at the end of this booklet.

NOTE: If you have licensed or assigned any rights to your registered intellectual properties, please discuss these items with the attorney
before transferring them into your trust. Provide copies of any license or assignment agreements you have signed.

BRIEF DESCRIPTION TYPE CERTIFICATE CERTIFICATE OWNER(S) OFFICE USE

NUMBER DATE

LAWSUIT JUDGMENTS:

Please list all judgments where you have been awarded money damages in a court proceeding. Enter the name and address of the
judgment debtor.

CASE NUMBER COURT JUDGMENT JUDGMENT DEBTOR OWNER(S) OFFICE USE

$
STATE & COUNTY:

$
STATE & COUNTY: __________
 Page 18

AUTOMOBILES, MOTORCYCLES, BOATS, RV'S, AIRPLANES, AND OTHER VEHICLES:

DESCRIPTION (YEAR, MAKE AND MODEL) TYPE REGISTRATION NUMBER NET MARKET VALUE OWNER(S) OFFICE USE

$
$
$
$
$

PERSONAL PROPERTY:

Please list the approximate value of all valuable art, jewelry, furniture, collections or other personal items with an individual value
exceeding $20,000 or for which you have an appraisal.

PROPERTY DESCRIPTION VALUE OFFICE USE

Husband’s Personal Property $

Wife’s Personal Property $
Both Husband’s and Wife’s Personal Property $

BURIAL PLOTS:
NAME AND ADDRESS OF BURIAL PLOT LOCATION TYPE VALUE OWNER(S) OFFICE USE

MEMBERSHIPS:

Please list all memberships that have monetary value and permit your interest to be transferred.

DESCRIPTION AND ADDRESS VALUE OWNER(S) OFFICE USE

$
 Page 19
OTHER ASSETS:

DESCRIPTION VALUE OWNER(S) OFFICE USE

$
$
$
$
$

INSURANCE:

Please answer the following questions, which will allow us to provide specific information about your estate plan to insurance
companies that are currently protecting the assets you are transferring into your trust.

POLICY NUMBER COMPANY NAME AND ADDRESS AGENT NAME OFFICE USE
AUTO INSURANCE

LIABILITY INSURANCE

Total Estimated Value of Estate: $_____________________________.

 Page 20

Acknowledgement by Clients
I/We hereby agree that I/we have completely and accurately filled out the above Asset Information Booklet, including all
assets owned by me/ us.

I/We also hereby agree that any assets which have not been listed on this Asset Information Booklet will NOT be transferred
into my/our living trust by KRASA LAW, and MAY be subject to Probate or other adverse consequences.

Dated:_________ Signature:__________________________________________________

Printed Name:_______________________________________________

Dated:_________ Signature:___________________________________________________

Printed Name:________________________________________________