Estate Planning Questionnaire Estate Planning Questionnaire Your InfoOld Planning DocumentsMarital StatusCitizenshipChildrenAssetsDebtsBeneficiariesFiduciariesIncapacity PlanOther InstructionsReview & Submit Getting started with your plan This questionnaire will collect information I will need to help you create your estate plan. At the end of each section , you have an opportunity to check a box to indicated if you have questions about that section, and insert your question or just jot down a note of the issue you would like to discuss further. At the end of the questionnaire, you will be provided with a summary of your responses to review before submitting the form. I will also ask for suggestions for how this online questionnaire might be improved. Your Information First Name Middle Name Last Name Alternate names (e.g. maiden name, other names by which you have been known or which appear on accounts or forms of identification) List all alternate names by which you have been known. (If more than one, separate with a comma or colon) Your Address Your Address Your Address Your Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Your date of birth (use six-digit format: MM-DD-YR) Your gender: male female Your Phone Your Email Old Planning Documents Δ