ESTATE PLANNING CHECKLIST - PAGE 3
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Investment Assets

(a) Publicly Traded Stocks and Corporate Bonds

Entity: Number of shares: Value:
Name, address and phone number of Agent for Transfer:

Entity: Number of shares: Value:
Name, address and phone number of Agent for Transfer:

Entity: Number of shares: Value:
Name, address and phone number of Agent for Transfer:

(b) Municipal Bonds

Entity: Number of shares: Value:
Name, address and phone number of Agent for Transfer:

Entity: Number of shares: Value:
Name, address and phone number of Agent for Transfer:

(c) Long-term U.S. Treasury Notes and Bonds

Denomination: Number: Expiration Date: Value:

Denomination: Number: Expiration Date: Value:

(d) Short-term U.S. Obligations (T-Bills)

(e) Limited Partnership Interests

Name: Value:
Name, address and phone number of agent:

(f) Other Investments. Please describe the general nature and value of other investment interests.

Investment: Type: Value:

Please bring bonds, stock certificates, and other investment documents to your initial interview.

Annuities

Annuity company:
Contract number: Current cash value:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):

Annuity company:
Contract number: Current cash value:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):

Annuity company:
Contract number: Current cash value:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):

Life Insurance on YOUR life

Insurance company: Policy number: Face amount:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):
Type of policy: Ordinary Term/Group Current cash value:
Loans: Accidental death benefits, if any:

Insurance company: Policy number: Face amount:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):
Type of policy: Ordinary Term/Group Current cash value:
Loans: Accidental death benefits, if any:

Life Insurance on Your SPOUSE's Life

Insurance company: Policy number: Face amount:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):
Type of policy: Ordinary Term/Group Current cash value:
Loans: Accidental death benefits, if any:

Insurance company: Policy number: Face amount:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):
Type of policy: Ordinary Term/Group Current cash value:
Loans: Accidental death benefits, if any:

Life Insurance on the Life of Another

Insurance company: Policy number: Face amount:
Owner of policy:
Primary beneficiary(ies):
Contingent beneficiary(ies):
Type of policy: Ordinary Term/Group Current cash value:
Loans: Accidental death benefits, if any:

Do you or your spouse have long term care insurance? Yes: No:
If yes, insurance company: Policy number:
Coverage:

Please bring policies and other relevant correspondence with you to your initial consultation.

Other Interests of Current or Future Value

1. Interests in trusts. Describe any trusts created by you or by any other person, such as a parent or ancestor, in which you or a member of your immediate family has a right to receive distributions of income or principal, whether or not such distributions are actually being received or anticipated in the future. Be as specific as you can. If possible, attach a copy of the trust agreement. If the trust agreement is not available, show the date the trust was created, whether it can be amended or changed, whether someone has a power of appointment over it, when the trust terminates, and who will receive the trust property upon termination. Also, state the approximate current value of the trust and the annual income from it.

2. Anticipated inheritances. If you or any other members of your immediate family are likely to receive substantial inheritances in the foreseeable future from persons other than yourself or your spouse, describe your best estimate of the value and the nature of each inheritance.

3. Other assets or interests of value. Describe the general nature, form or ownership, and your estimate of the value of any asset or interest of value that does not seem to fit in any of the categories above.

Liabilities

Describe here substantial financial liabilities not reflected in the asset information you have provided above. If they are secured, indicate the nature of the security. Also show any substantial contingent liabilities, such as personal guarantees you have made on obligations of a business, a family member, or any other person. Indicate whether you have insured against any of these obligations in the event of your death, or if the obligations do not survive your death.

Please bring all relevant documents to your initial interview.