Date:

P E R S O N A L   I N F O R M A T I O N

Full Legal Name:

Social Security Number:

Address:

Phone Home:

Work:

Date of Birth:

Place of Birth:

Marital Status:

Spouse Full Legal Name:

Spouse SSN:

Date of Marriage:

Place of Marriage:

Names of children: include children from current marriage (CM), children from previous marriage (PM), adopted children (A), step-children (S), and predeceased children (PD). Also, indicate whether married and their Social Security Number.

Name / SSN

Address

Date of Birth

Names of any grandchildren from predeceased children:

Bequests of specific property:

Name (Relationship & Age)

Address

Bequest

General bequests of property:

Name (Relationship & Age)

Address

Bequest

Executor:

Name (relationship, if any)

Address

Age

First Choice

Second Choice

Information Regarding Trusts:

Name

Address

Relationship

First Choice Trustee

Second Choice Trustee

Co-Trustee(s) (if desired)

Distributions from Trust:

Age To Be Made

Amount Made At Each Age

Determine Assets, Liabilities and Life Insurance Beneficiaries.

List in detail the Insurance policies and companies and numbers and who the beneficiaries are as well as the identifying number of the policy or retirement account, and the address of the company.