Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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