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Estate Planning Questionnaire Form

Please complete the following form to get started.

Note: “Save and Continue Later” functionality allows you to return to your form if needed. Only completed pages of your form will be saved in the system – hit the Next button to save your work on the current page.

"*" indicates required fields

Step 1 of 10 - General

10%

General

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Legal Name*
First Name
Middle Initial
Last Name
(Maiden Name)
 
Are you an Arizona resident?*

Contact Information

Permanent Home Address*

Employment

Work Address

Family and Partnership

Are there any minor children?
Do you have a spouse or domestic partner?*
Are you legally married?*

Spouse or Partner

This field is hidden when viewing the form
Spouse Legal Name*
First Name
Middle Initial
Last Name
(Maiden Name)
 

Spouse/Partner Contact Information

Spouse/Partner Employment

Work Address
* Please use mm/dd/yy format for any date listings.
Your Living Parents
Full Name
Date of Birth (mm/dd/yy)
 
Spouse's Living Parents
Full Name
Date of Birth (mm/dd/yy)
 
Your Living Siblings
Full Name
Date of Birth (mm/dd/yy)
 
Spouse's Living Siblings
Full Name
Date of Birth (mm/dd/yy)
 
Children (including natural and adopted)
Full Name
Date of Birth (mm/dd/yy)
From prior relationship? (y/n)
 
Please list all persons or charitable organizations who will inherit estate property
Full Name
Address
 
Notes (for attorney use)







PRIMARY Personal Representative

Person to carry out provisions of your Will (also known as an Executor of the Will)
My Spouse/Partner will be my Primary Personal Representative
(Same contact information indicated previously)
Is bond or other security required of personal representative?
(A bond is a form of security that in most cases takes the form of an insurance policy that protects beneficiaries in case the Personal Representative fails to properly perform his/her duties.)

Will you serve as Primary Personal Representative for your Spouse/Partner?
Is bond or other security required of spouse/partner's personal representative?
(A bond is a form of security that in most cases takes the form of an insurance policy that protects beneficiaries in case the Personal Representative fails to properly perform his/her duties.)

ALTERNATE Personal Representative

(If your Primary Personal Representative cannot perform his/her duties for whatever reason, your Alternate Representative would assume those duties.)
Do you have additional alternate Personal Representatives?
Your Additional Alternate Personal Representatives
Full Name
Relationship to Client
 

Does your spouse have additional alternate Personal Representative?
Spouse Additional Personal Representatives
Full Name
Relationship to Client
 

PRIMARY Successor Trustee for a Family Trust

The general duty of a Successor Trustee is to administer the provisions of the trust in a timely manner for the benefit of the beneficiaries. You and your spouse/partner are the initial Trustees. Your Successor Trustee steps in upon your deaths or incapacity.
Is bond or other security required of successor trustee?

ALTERNATE Successor Trustee

(If your Primary Successor Trustee cannot perform his/her duties for whatever reason, your Alternate Representative would assume those duties.)
Do you have additional alternate Successor Trustees?
Your Additional Alternate Successor Trustees
Full Name
Relationship to Client
 

PRIMARY Guardian for Minor Children

(A surviving spouse would typically be the guardian of any minor children. If there is no surviving spouse, another guardian(s) should be named.)
Your Primary Guardian Address

ALTERNATE Guardian for Minor Children

(If your Primary Guardian for Minor Children cannot perform his/her duties for whatever reason, your Alternate Representative would assume those duties.)
Your Alternate Guardian Address
Do you have additional alternate Guardians?
Your Additional Alternate Guardians
Full Name
Relationship to Client
Full Address
 

PRIMARY Agent for Financial Power of Attorney

(Person to make financial decisions on your behalf)
My Spouse/Partner will be my Primary Agent for Financial Power of Attorney
(Same contact information indicated previously)

Will you serve as Primary Agent for your Spouse/Partner?

ALTERNATE Agent for Financial Power of Attorney

(If your Primary Agent for Financial Power of Attorney cannot perform his/her duties for whatever reason, your Alternate Representative would assume those duties.)
Do you have additional alternate agents?
Your Additional Alternate Agents
Full Name
Relationship to Client
 

Does your spouse have additional alternate agents?
Spouse Additional Agents
Full Name
Relationship to Client
 

PRIMARY Health Care Agent

(Person to make health care decisions on your behalf if you are unable)
My Spouse/Partner will be my Primary Health Care Agent
(Same contact information indicated previously)
Your Primary Health Care Agent Address*

Will you serve as Primary Health Care Agent for your Spouse/Partner?
Spouse/Partner Primary Health Care Agent Address*

ALTERNATE Health Care Agent

(If your Primary Health Care Agent cannot perform his/her duties for whatever reason, your Alternate Representative would assume those duties.)
Your Alternate Health Care Agent Address
Do you have additional alternate Health Care Agents?
Your Additional Alternate Health Care Agents
Full Name
Relationship to Client
Preferred Phone Number
Full Address
 

Spouse Alternate Health Care Agent Address
Does your spouse have additional alternate Health Care Agents?
Spouse Additional Alternate Health Care Agents
Full Name
Relationship to Client
Preferred Phone Number
Full Address
 

Property and Liabilities

Please list all applicable items in the fields below.

Click the "+" icon to add items.

Cash and Deposit Bank Accounts
Item (Type of Account)
Bank or Financial Institution
Approximate Value
 
IRA's and SEP IRA's
Item
Bank or Financial Institution
Approximate Value
 
Other Property & Assets
Stocks, Bonds, Notes, Mortgages paid to you, Deeds of Trust
Item
Approximate Value
 
Business Entities (LLCs or Corporations)
Item
State Entity Was Formed
% Ownership
 
Life Insurance
Item
Approximate Value
 
Retirement Plans
Item
Approximate Value
 
Motor Vehicles You Own
Year/Make/Model
Approximate Value
Liens? (yes/no)
 
Real Property
(Homes, land and other real estate that you own)
Address or Location
Approximate Value
Amount Owed
 
Liabilities
Item
Approximate Value
 

Form Submission

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Suite 145
Scottsdale, AZ 85254
Phone: (602) 971-4800
Fax: (602) 953-3621
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Suite 180
Tucson, AZ 85718
Phone: (520) 615-3100
Fax: (520) 615-3110
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Paradise Valley

11811 N. Tatum Blvd.
Suite 3031
Phoenix, AZ 85028
Phone: (480) 795-5300
Fax: (602) 953-3621
Map  |  Details

Show Low

141 N. 6th Street
Show Low, AZ 85901
Phone:  (602) 971-4800
Fax: (602) 953-3621
Map  |  Details

The information contained on this website does not constitute legal advice and no attorney-client relationship is created. © 2024 Loose Law Group, P.C.
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