Name:
Date:
1. Have you ever prepared a Will?
2. Is it currently out of date?
3. Have you ever prepared a Living Trust?
4. Is it currently out of date?
5. Do you have a current Durable Power of Attorney?
6. Do you have a Living Will?
7. Do you have a DNR (Do Not Resuscitate) order in place?
8. Have you ever made a gift of over $10,000?
9. Have you ever been a resident of a community property state
10. Are you a current beneficiary of a trust?
11. Are you currently receiving Social Security?
12. Are you currently receiving any other government benefits? Describe:
13. Do you have a written marital agreement in effect?
14. Did you or your spouse serve in the military during a time of war (WWII, Korea, Vietnam, Gulf War)?
15. Are you a surviving spouse of a veteran?
16. Are you receiving military retirement pay?
17. Have you ever been widowed?
18. Are you a non -US citizen?
19. Do you have a disabled/handicapped child?
20. Do you have pets that need special consideration?
21. Have any of your children died?
22. If so, did he or she leave any surviving children?
23. Have you ever adopted a child?
24. Do you (or does anyone in your immediate family) have any cryogenically preserved (frozen) eggs, sperm, or embryos?
25. Do you have any children or family members that are not genetically related to you (i.e., “ART” children, meaning those born by means of “assisted reproductive technology”)?
26. Have you entered into a “Designated Beneficiary Agreement ” with another person?
27. Are you partially or totally supporting another family member
28. Are you considering disinheriting one or more of your children? Who?
29. Are any of your children struggling with alcohol, drugs, gambling, the IRS, legal problems, debt or disabilities?
30. On a scale of 1 to 10, with 10 being “great ” would you rank any of your children less than a 7 with respect to financial and/or family care issues?
31. Using the scale above, would you rank any of your children's spouses less than a 7?
32. Would you characterize any of your children's spouses as “overly controlling? ”
33. Do you have concerns that an inheritance left to one or more of your children would disappear sooner than later?
34. Do you want to make a special effort to provide for your grandchildren?
35. Do you think any of your children may have estates over $1,000,000, not including life insurance?
36. Do you worry about running out of money before you die?
37. Do you worry that your monthly income won't keep pace with your monthly expenses?
38. Do you own your own business?
39. Does your business value constitute more than one-third of of your net worth?
40. Have you made any loans to friends or family members that you want to consider in your planning?
41. Have you co-signed on a loan with another or helped a child get a mortgage loan on a new home purchase
42. Do you anticipate an inheritance from anyone in excess of $100,000?
43. Are either of your parents living?
44. Do you have a close friend or family member now in or about to go in an assisted living and/or a nursing home ?
45. Do you have a serious health problem that concerns you about your future confinement in a nursing home?
46. If you don't already have one, would you be interested in learning about a pre-need (pre-paid) funeral plan? If so, are you ok with receiving a call from one of our pre-need advisors? Y / N
47. Do you have long-term care insurance?
48. Do you have disability insurance?
49. Have you ever been denied long-term care insurance?
50. If you are living with another person and have never been ceremonially married, do you wonder whether or not you are legally married?
51. Do you and your spouse/partner/significant other have separate children?
52. Do you own any real estate outside of Colorado (even if its with other family members, a timeshare or an oil and gas interest)?
53. If you are married, do you own any real estate solely in your own name?
54. If you are married, do you have any property that you want to make certain passes to your child or children, bypassing your spouse (such as a family cabin, farm, keepsake jewelry, inherited securities, etc.)?
55. Do you have a strong desire to leave a significant share or or your estate to one or more charities as primary or secondary estate beneficiaries?
56. Do you have a financial planner/advisor? Who?
57. Do you have a tax preparer ? Who?
Please state any other issues or concerns that you would like to address that were not noted above:
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