Ten Minute Questionnaire for The Family Trust Solution

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TEN MINUTE QUESTIONNAIRE FOR

THE FAMILY TRUST SOLUTION

For Couples

If you would like to print out the form and then email it, please use the
print version of the form. If question does not apply to you, please type "DNA" (does not apply).

	Mr.Mrs.MissMs.Dr.Other
Your Full Legal Name:
Your Nickname, if any:
Your Address:
City:
State:
ZIP Code:
Home Phone:
Work Phone: (including extension)
Cell Phone:
Your Email:
Your Date of Birth (mm/dd/yyyy):
Your Occupation:
Your Job Title:
Your Employer:
Estimated Annual Income:	$
Are you a U.S. citizen?	YesNo
In what state are you domiciled?
Are you healthy?	YesNo
	If not, please explain:

	Mr.Mrs.MissMs.Dr.Other
Spouse's Full Legal Name:
Spouse's Nickname, if any:
Spouse's Work Phone: (including extension)
Spouse's Cell Phone:
Spouse's Email:
Spouse's Date of Birth:
Spouse's Occupation:
Spouse's Job Title:
Spouse's Employer:
Spouse's Estimated Annual Income:	$
Is your spouse a U.S. citizen?	YesNo
In what state is your spouse domiciled?
Is your spouse healthy?	YesNo
	If not, please explain:

Do either of you own any property in a land trust?	YesNo
Do you have a pre-nuptial agreement?	YesNo
Do you have an umbrella insurance policy?	YesNo
If yes, who is your insurance carrier?
What is your coverage limit?	$
Are you or your spouse subject to a divorce decree?	YesNo
Are there any pending or threatened claims or suits against you or your spouse?	YesNo
Are you or your spouse a trustee, director, fiduciary, or retirement/investment plan administrator?	YesNo
Other than tax savings, what are your estate planning goals?
Where is your safe deposit box located? (Leave blank if not applicable.)
Is this a first marriage for both spouses?	YesNo
Please enter your children's full legal names, dates of birth, health status, marital status, and number of descendants. If this question does not apply to you, please type "DNA" (Does Not Apply).
Please enter your spouse's children's full legal names, dates of birth, health status, marital status, and number of descendants. If this question does not apply to you, please type "DNA" (Does Not Apply).
If you have minor children, who would act as their guardian if you could not? (Also, please name a successor guardian if you can.)
Who would make medical decisions for you and your spouse in the event you could not make them for yourselves? Please name a successor if the first person you choose cannot act.
You:
Your spouse:
Where would you have your assets go in the event of a catastrophe in which your nuclear family was lost? Specify details below:

Do you or your spouse anticipate an inheritance?	YesNo
Have you or your spouse ever lived in a community property state (CA, WI, AZ, NM, TX, ETC.)?	YesNo
Have you or your spouse ever filed a gift tax return?	YesNo
Are you or your spouse a beneficiary of any trust?	YesNo
Are you or your spouse charitably inclined?	YesNoMaybe
If so, please elaborate:
What is the name and phone number of your accountant?
What is the name and phone number of your financial advisor, and for what institution does he/she work?
Do you or your spouse know of any other clients of Robert T. Napier or the firm?

THIS QUESTIONNAIRE IS INTENDED TO SUPPLY OVERVIEW INFORMATION ONLY. REMINDER: Bring your existing estate planning documents, if available. BALANCE SHEET Please do not include "$" signs or commas.
	SPOUSE A	SPOUSE B	JOINT
Home	$	$	$
Other Real Estate	$	$	$
Stocks, Bonds	$	$	$
401(k), Keogh, etc.	$	$
IRA	$	$
Roth IRA	$	$
Private Placements	$	$	$
Cash	$	$	$
Insurance - Death Benefit	$	$	$
Business Interests	$	$	$
Notes Receivable	$	$	$
Other	$	$	$


Debts	$	$	$
Mortgage(s) on Home	$	$	$
Other	$	$	$

How did you learn of us?
I have reviewed this form, and I am ready to submit.
If you would like to print out the form and then email it, please use the print version of the form.

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