Download Financial Information Packet(1)

WILSON ELDER LAW CENTER
JAMES W. WILSON, ESQ.
FINANCIAL INFORMATION PACKET
Please complete this packet as thoroughly as possible. Creating an estate plan
that works will be based on the information you provide us. The information is
imperative to allow the attorney to recommend an estate plan best suited to your
individual needs.

Answer each section as completely as possible

Print legibly

Check all appropriate boxes including “No” and “None” boxes

If necessary, please call our office or consult with your financial advisor for
assistance
All information contained in this document is confidential
and protected by attorney-client privilege.
2113 Government Place, Bldg. M
Ocean Springs, MS 39564
228-872-3123 or 1-877-385-7393
Fax: 228-872-3379
INSTRUCTIONS FOR COMPLETING THE FINANCIAL INFORMATION
GENERAL: These instructions are designed to help you list all the property that you own, how it is
titled and its present value. If you own more property than space allows you to list,
please use an extra sheet of paper and attach it to this packet or use the back of the
sheet.
ASSETS:
Immediately after the heading for each form of property is a brief explanation of what
property you should list under that heading.
OWNER:
How you own your property is extremely important for purposes of properly designing
and implementing your living trust. For each property category, there is a column titled
“Owner.” When filling in this column, please use the following abbreviations:
FOR PROPERTY OWNED IN:
WITH:
Single
If you are single and own
property in your name only
I
Husband’s Name
No other person
H
Wife’s Name
No other person
W
Joint
A Spouse
or
Someone other than your
spouse
Tenancy In Common
Unknown
USE:
A Spouse
or
Someone other than your
spouse
If you cannot determine how
the property is owned
JTS
JTO
TCS
TCO
?
IF YOU RUN OUT OF SPACE IN ANY SECTION,
PLEASE CONTINUE ON THE BACK OF THAT SHEET
James W. Wilson, Esq.
2
INCOME INFORMATION
Name:

Employed
Retired
Occupation/Position:
Employer:
Employer’s Address:
Business Phone:
Annual Salary: $
Pension - Monthly Payment: $
Source:
Rental Income - Monthly Payment: $
Source:
Social Security - Monthly Payment: $
Disability - Monthly Payment: $
Source:
Investment/Dividend - Monthly Payments $
Source:
Spouse: (if applicable)
Name:
Employed
Retired
Occupation/Position:
Employer:
Employer’s Address:
Business Phone:
Annual Salary: $
Pension - Monthly Payment: $
Source:
Rental Income - Monthly Payment: $
Source:
Social Security - Monthly Payment: $
Disability - Monthly Payment: $
Source:
Investment/Dividend - Monthly Payments $
Source:
James W. Wilson, Esq.
3
 CASH ACCOUNTS
N/A
TYPE: Checking Accounts “CA”; Savings Accounts “SA”; Certificates of Deposit “CD”;
Money Market Accounts “MM” & Cash Management Accounts “CM”
OFFICE USE
ONLY
Bank/Credit Union:
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Bank/Credit Union:
Yes
Yes
No
No
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Bank/Credit Union:
Yes
Yes
No
No
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Bank/Credit Union:
Yes
Yes
No
No
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Bank/Credit Union:
Yes
Yes
No
No
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Bank/Credit Union:
Yes
Yes
No
No
Account Type: _______ Owner:__________
Rec’d initial
Branch Address:_________________________________________Phone:________________
Account No. ______________________ ATM privileges with this account?
Are funds electronically transferred to or from this account?
Account Balance: $
Yes
Yes
No
No
TOTAL CASH: $
James W. Wilson, Esq.
4
 BROKER-HELD INVESTMENT ACCOUNTS
(not IRA/Retirement Accounts)
N/A
TYPE: Investment Accounts “I”; & Money Fund Accounts “MF”
OFFICE
USE ONLY
Rec’d initial
Brokerage Firm: _____________________ Account Type: _______ Owner: __________
Branch Address: _________________________________________ Phone: __________
Account No.
Is this account pledged as collateral for a loan?
Are funds electronically transferred to or from this account?
Yes
Yes
No
No
Account Balance: $
Rec’d initial
Brokerage Firm: _____________________ Account Type: _______ Owner: __________
Branch Address: _________________________________________ Phone: __________
Account No.
Is this account pledged as collateral for a loan?
Are funds electronically transferred to or from this account?
Yes
Yes
No
No
Account Balance: $
Rec’d initial
Brokerage Firm: _____________________ Account Type: _______ Owner: __________
Branch Address: _________________________________________ Phone: __________
Account No.
Is this account pledged as collateral for a loan?
Are funds electronically transferred to or from this account?
Yes
Yes
No
No
Account Balance: $
TOTAL: $
 RETIREMENT PLANS
N/A
TYPE: Profit Sharing “PS”; H.R. 10; IRA; SEP; 401(K), etc.
OFFICE
USE ONLY
Company Name: _______________________
Plan Type: __________ Owner: __________
Rec’d initial
Company Address: _________________________________________
Account Number: ______________ Beneficiary: __________________ Value: $ __________
Are you currently receiving benefits/payments from this plan?
Company Name: _______________________
Yes
No
Plan Type: __________ Owner: __________
Rec’d initial
Company Address: _________________________________________
Account Number: ______________ Beneficiary: __________________ Value: $ __________
Are you currently receiving benefits/payments from this plan?
Company Name: _______________________
Yes
No
Plan Type: __________ Owner: __________
Rec’d initial
Company Address: _________________________________________
Account Number: ______________ Beneficiary: __________________ Value: $ __________
Are you currently receiving benefits/payments from this plan?
Yes
No
TOTAL: $
James W. Wilson, Esq.
5
STOCKS
N/A
Stock in publicly-owned corporations that you hold; not stocks in private or
family business
OFFICE
USE ONLY
Rec’d initial
Stock Name:
Owner: __________ No. of Shares: ________
Fair Market Value: $ _________ Transfer Company: __________________________________
Transfer Company _________________________________________
Address:_______________________________________________________________
Is this stock pledged as collateral on any loan?
Stock Name:
Yes
No
Owner: __________ No. of Shares: ________
Rec’d initial
Fair Market Value: $ _________ Transfer Company: __________________________________
Transfer Company _________________________________________
Address:_______________________________________________________________
Is this stock pledged as collateral on any loan?
Stock Name:
Yes
No
Owner: __________ No. of Shares: ________
Rec’d initial
Fair Market Value: $ _________ Transfer Company: __________________________________
Transfer Company _________________________________________
Address:_______________________________________________________________
Is this stock pledged as collateral on any loan?
Yes
No
TOTAL: $
 BONDS
N/A
U.S. Savings Bonds, Treasury Bonds, corporate bonds, municipal bonds, etc.
OFFICE
USE ONLY
Rec’d initial
Bond Type:
Owner: ___________ Co-Owner:
________
Bond Number _______________ Date Purchased: ____________ Face Value: $
Bond Type:
Owner: ___________ Co-Owner: ________
Rec’d initial
Bond Number _______________ Date Purchased: ____________ Face Value: $
Bond Type:
Owner: ___________ Co-Owner: ________
Rec’d initial
Bond Number _______________ Date Purchased: ____________ Face Value: $
TOTAL: $
IF YOU OWN U.S. SAVINGS BONDS AND HAVE A DETAILED LIST, PLEASE ATTACH OR
PLEASE BRING WITH YOU TO DESIGN MEETING.
James W. Wilson, Esq.
6
 LIFE INSURANCE
N/A
OFFICE USE
ONLY
Term, Whole Life, Split Dollar, Group Term Life
Company:
Phone:
Policy Type: ___________ Policy Number: ___________ Owner: ________
Insured:
Beneficiary:
Face Value: $
Death Benefit: $____________ Cash Value: $ ________
Loan Against Policy?
Yes
No
Company:
Phone:
Rec’d initial
Representative/Agent:
Amount of Loan: $
Rec’d initial
Representative/Agent:
Policy Type: ___________ Policy Number: ___________ Owner: ________
Insured:
Beneficiary:
Face Value: $
Loan Against Policy?
Death Benefit: $____________ Cash Value: $ ________
Yes
No
Amount of Loan: $
TOTAL: $
 ANNUITIES
OFFICE USE
ONLY
N/A
Company: _______________________ Representative/Agent:________________________
Phone: _____________________ Contract Date:
Roll-over?
Policy Type:
Owner:______________ _
Policy Number:
Yes
Rec’d initial
No
Beneficiary: _______________ Initial Investment: $_________ Current Value: $ __________
Is this Annuity part of an Brokerage Account?
Yes
No
Brokerage: ___________________________ Account Number _____________________
Are you currently receiving withdrawals from this plan?
Company:
Yes
No
Amount: $______
Rec’d initial
Representative/Agent:
Phone: _____________________ Contract Date:
Roll-over?
Policy Type:
Owner: _______________
Policy Number:
Yes
No
Beneficiary: _______________ Initial Investment: $_________ Current Value: $ ___________
Is this Annuity part of an Brokerage Account?
Yes
No
Brokerage: ___________________________ Account Number _____________________
Are you currently receiving withdrawals from this plan?
Yes
No Amount: $______
TOTAL: $
Brokerage: ___________________________ Account Number _____________________
Are you currently receiving withdrawals from this plan?  Yes  No Amount: $______
James W. Wilson, Esq.
7
 REAL ESTATE
N/A
Land; buildings; homes. Where you have either a deeded or land contract interest (land or buildings)
that you own in partnership with someone else, that property should be listed in
OFFICE
“Partnership Interests” section.
USE ONLY
Rec’d initial
Property Address: _______________________________County:_________________
Permanent Parcel Number: ___________ Owners:____________________________
Primary Residence
Second Home
Camp
Rental Property
Business Property
Land
Year Purchased: ________ Purchase Price: $________ Assessed Value: $_________
Is there a Mortgage?
Yes
No Loan Number: ____________ Amount: $ _________
Lender: ______________________ Representative: __________________________________
Address: ____________________________________________ Phone:_________________
Insurance Carrier: __________________________ Representative:______________________
Address: ____________________________________________ Phone:__________________
Policy Number:
Rec’d initial
Property Address: _______________________________County:_________________
Permanent Parcel Number: ___________ Owners:____________________________
Primary Residence
Second Home
Camp
Rental Property
Business Property
Land
Year Purchased: ________ Purchase Price: $________ Assessed Value: $_________
Is there a Mortgage?
Yes
No Loan Number: ____________ Amount: $_________
Lender: ______________________ Representative:__________________________________
Address: ____________________________________________ Phone:_________________
Insurance Carrier: __________________________ Representative:______________________
Address: ____________________________________________ Phone:__________________
Policy Number:
Rec’d initial
Property Address: _______________________________County:_________________
Permanent Parcel Number: ___________ Owners:____________________________
Primary Residence
Second Home
Camp
Rental Property
Business Property
Land
Year Purchased: ________ Purchase Price: $________ Assessed Value: $_________
Is there a Mortgage?
Yes
No Loan Number: ____________ Amount: $_________
Lender: ______________________ Representative: _________________________________
Address: ____________________________________________ Phone:_________________
Insurance Carrier: __________________________ Representative:______________________
Address: ____________________________________________ Phone:__________________
Policy Number:
TOTAL: $
James W. Wilson, Esq.
8
MOTOR VEHICLES
N/A
Automobiles; motorcycles; motor homes; boats; snowmobiles; airplanes; etc.
Type: ___________ Year, Make, Model: ________________________ Owner:_____________
OFFICE USE
ONLY
Rec’d initial
Insurance Carrier: ______________ Phone: ____________ Primary Driver:______________
Lien Against Vehicle
Yes
No
Lender: _________________________________
Address: ________________________________________________ Phone:________ _____
Lien Amount: $ _________
Present Value: $________
Fair Market
Book Value
Type: ___________ Year, Make, Model: ________________________ Owner:_____________
Rec’d initial
Insurance Carrier: ______________ Phone: ____________ Primary Driver:______________
Lien Against Vehicle
Yes
No Lender: _________________________________
Address: ________________________________________________ Phone:_____________
Lien Amount: $ _________
Present Value: $________
Fair Market
Book Value
Type: ___________ Year, Make, Model: ________________________ Owner:_____________
Rec’d initial
Insurance Carrier: ______________ Phone: ____________ Primary Driver:______________
Lien Against Vehicle?
Yes
No
Lender: _________________________________
Address: ________________________________________________ Phone:_____________
Lien Amount: $ _________
Present Value: $________
Fair Market
Book Value
TOTAL: $

 SOLE PROPRIETORSHIPS
N/A
All of the assets used by you in a sole proprietorship type of business ownership
Name of Business:____________________________
Owner: ________________________
OFFICE USE
ONLY
Rec’d initial
Business Address: ___________________________________________________________
Business Description: _________________________________________________________
Is this a Professional Business?
Yes
No
Is Business Property Owned?
Yes
No
Business Insurance Agent: _________________ Address: ____________________________
Business Attorney: _______________________ Address______________________________
Business Value: $ __________________
Does this include Property Value
Yes
No

James W. Wilson, Esq.
9
 CORPORATE BUSINESS INTERESTS
N/A
OFFICE USE
ONLY
Privately-owned stock (non-publicly traded)
Company Name:
Owner: _________________________
Rec’d initial
Address:__________________________________________________________________
Number of Shares: _______ Percentage of Ownership:
Buy/Sell Agreement?
Yes
% Value: $
Is this an “S” Corporation?
No
Is this a Medical, Legal or other Professional Corporation?
Yes
Yes
No
No
FARM & RANCH INTERESTS
N/A
OFFICE USE
ONLY
Livestock; machinery, leases, etc.
Type: ___________________ Owner:
%
Fair Market Value: $ ___________
Rec’d initial
Physical Description:________________________________________________________
Location:
 PARTNERSHIP & LLC INTERESTS
N/A
OFFICE USE
ONLY
General and limited partnerships.
Please show the percentage interest you have as a partner.
Name of Partnership: ___________________ Is this a Professional Partnership?
Yes
No
Rec’d initial
Address:___________________________________________________________________
Owners: ___________________________________________________________________
Entity Type:
General Partnership
Buy/Sell Agreement?
Yes
Limited Partnership
No
Limited Liability Company
Who holds Partnership Papers?_________________
Address:
Phone:
Name of General or Managing Partner:_
Partnership Value: $__________

OTHER ASSETS
N/A
Other property that does not fit into any other category listed in this
information packet.
Type:
Owner: _______________ Purchase or Gift? ______________
OFFICE USE
ONLY
Rec’d initial
Detailed Description:_________________________________________________________
Value: $
Type:
Is this a:
Fair Market Value
Appraisal Quote
Owner: _______________ Purchase or Gift?
Rec’d initial
Detailed Description:_________________________________________________________
Value: $
Is this a:
Fair Market Value
Appraisal Quote
James W. Wilson, Esq.
10
MORTGAGES, NOTES & OTHER RECEIVABLES
N/A
OFFICE USE
ONLY
Mortgages or promissory notes payable to you; other monies owed to you.
Name of Debtor: ____________________________
Business Debt
Personal Debt
Rec’d initial
Address: ____________________________________________ Phone:_________________
Owed To: _____________________ Date Payable or Payment Schedule: ________________
Date Debt Incurred: _________ Original Amount: $_________ Current Amount: $________
Promissory Note?
Yes
No Reason for Debt:
ANTICIPATED INHERITANCE, GIFT OR LAWSUIT JUDGMENT
N/A
Gifts or inheritances you expect to receive in the future;
monies you anticipate receiving through a judgment or settlement of a lawsuit.
Type: ______________ From Whom:_________________ Anticipated Value: $___________
OFFICE USE
ONLY
Rec’d initial
Description:
Attorney & Address:___________________________________________________________
___________________________________________________________________________

PERSONAL PROPERTY
N/A
Household furnishings, jewelry, art work, china, collections, furs, antiques,
appliances, tools, etc., each with a minimum value of $1,000 or
substantial sentimental value or a bequest you intend to make
Type:
Owner:
Purchase or Gift?____________
OFFICE USE
ONLY
Rec’d initial
Description:
Value: $___________
Is this a:
Will This Be a Gift Or Bequest?
Fair Market Value
Yes
Do You Consider the Primary Value as:
Type:
No
Appraisal Quote
To Whom?
Monetary Value
Owner:
Sentimental Value
Both
Purchase or Gift?____________
Rec’d initial
Description:
Value: $___________
Is this a:
Will This Be a Gift Or Bequest?
Fair Market Value
Yes
Do You Consider the Primary Value as:
James W. Wilson, Esq.
No
Appraisal Quote
To Whom?
Monetary Value
Sentimental Value
Both
11
OFFICE USE
ONLY
Type:
Owner:
Purchase or Gift?____________
Rec’d initial
Description:
Value: $___________
Is this a:
Will This Be a Gift Or Bequest?
Fair Market Value
Yes
Do You Consider the Primary Value as:
Type:
No
Appraisal Quote
To Whom?
Monetary Value
Owner:
Sentimental Value
Both
Purchase or Gift?____________
Rec’d initial
Description:
Value: $___________
Is this a
Will This Be a Gift Or Bequest?
Fair Market Value
Yes
Do You Consider the Primary Value as:
Type:
No
Appraisal Quote
To Whom?
Monetary Value
Owner:
Sentimental Value
Both
Purchase or Gift?____________
Rec’d initial
Description:
Value: $___________
Is this a:
Will This Be a Gift Or Bequest?
Fair Market Value
Yes
Do You Consider the Primary Value as:
No
Appraisal Quote
To Whom?
Monetary Value
Sentimental Value
Both
TOTAL: $
James W. Wilson, Esq.
12