Financial Data Questionnaire

Main Menu Table of Contents Copyright Disclaimer Questionnaires FCS Home Page Elder Law Section Contributing Attorneys Related Links NC General Assembly

To help you prepare to see your attorney, you may use the following questionnaire to compile information your attorney will need to help you develop an estate plan. Your attorney may prefer to use other questionnaires and may need additional information. Call your attorney before your appointment to see what information he or she may need. You may use the following questionnaire, either by typing your answers directly on the screen or by printing a blank copy and filling out the hard copy. If you choose to type in your answers directly on the screen, print a copy when you are finished. Exiting the program will lose any information you have typed into the questionnaire. Do not try to save your answers in a file because your answers will be erased in the saved file. You will not be asked to transmit your answers over the phone line, so your answers are as secure as your computer. Tip: Print the file often to make sure that you do not lose the information you have entered. Or, fill out a hard copy first, and then enter the information on the computer screen to print.

To help you plan your estate, your attorney needs information about your financial affairs. The following questionnaire provides a bare minimum of information. Your attorney may ask for additional information. The section, Information Needed may provide additional guidance.

Name:

1. Ownership of liquid assets (check all that apply):

Bank account(s) Average balance
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Savings account(s). Average balance
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Money market account(s). Average balance
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Certificate(s) of deposit. Average balance
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Other. Average balance
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Stocks. Fair market value
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Bonds. Fair market value
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

U.S. savings bonds. Fair market value
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
If jointly owned, is there a right of survivorship? Yes No

Note: Clicking Reset will erase the above information.

2. Real property owned (check all that apply):

Personal residence. Fair market value:
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
Amount of mortgage owed:
Date acquired:

Vacation home. Fair market value:
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
Amount of mortgage owed:
Date acquired:

Rental property. Fair market value:
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
Amount of mortgage owed:
Date acquired:

Other real property. Fair market value:
In whose name? Mine Spouse Jointly with spouse Jointly with someone else
Amount of mortgage owed:
Date acquired:

Note: Clicking Reset will erase the information up to the previous Reset button.

3. Miscellaneous assets (check all that apply):

Automobile #1. Estimated value:
Automobile #2. Estimated value:
Automobile #3. Estimated value:
Automobile #4. Estimated value:

Boats. Estimated value:
Trailers/Mobile homes. Estimated value:
RV. Estimated value:
Motorcycle. Estimated value:

Home furnishings. Estimated value:
Jewelry. Estimated value:
Jewelry owned by spouse. Estimated value:
Coin collections. Estimated value:
Antiques. Estimated value:
Gun collections. Estimated value:
Art collection. Estimated value:
Computer/electronics. Estimated value:

Livestock. Estimated value:
Business machinery. Estimated value:
Crop inventory. Estimated value:
Business inventory. Estimated value:

Other assets not listed. Estimated value:
Amounts owed to you by others. Amount owed:

Note: Clicking Reset will erase the information up to the previous Reset button.

4. Employee benefit plans (check all that apply):

Pension plan. Estimated value:
Profit sharing plan. Estimated value:
Employee stock plan. Estimated value:
Individual Retirement Account. Estimated value:
Keogh plan. Estimated value:
Other retirement plans. Estimated value:

Note: Clicking Reset will erase the information up to the previous Reset button.

5. Liabilities (amounts you owe to someone else, except for real property) (check all that apply):

Car loans. Amount owed:
Credit card debt. Amount owed:
Personal loans. Amount owed:
Business loans. Amount owed:
State income taxes. Amount owed:
Federal income taxes. Amount owed:
Property taxes. Amount owed:
Other taxes. Amount owed:
Other loans. Amount owed:

Note: Clicking Reset will erase the information up to the previous Reset button.

6. Insurance on your life. (check all that apply);

Whole life insurance. Face amount:
Beneficiaries:
Owner of policy:

Whole life insurance. Face amount:
Beneficiaries:
Owner of policy:

Term life insurance. Face amount:
Beneficiaries:
Owner of policy:

Term life insurance. Face amount:
Beneficiaries:
Owner of policy:

Other insurance. Face amount:
Beneficiaries:
Owner of policy:

Other insurance. Face amount:
Beneficiaries:
Owner of policy:

Note: Clicking Reset will erase the information up to the previous Reset button.

7. Insurance on your spouse's life (check all that apply):

Whole life insurance. Face amount:
Beneficiaries:
Owner of policy:

Whole life insurance. Face amount:
Beneficiaries:
Owner of policy:

Term life insurance. Face amount:
Beneficiaries:
Owner of policy:

Term life insurance. Face amount:
Beneficiaries:
Owner of policy:

Other insurance. Face amount:
Beneficiaries:
Owner of policy:

Other insurance. Face amount:
Beneficiaries:
Owner of policy:

Note: Clicking Reset will erase the information up to the previous Reset button.

8. Trusts (check all that apply):

I am beneficiary of a trust. Value of trust:
I am trustee or co-trustee of a trust. Value of trust:
I have created a trust. Value of trust:

9. Income (check all that apply):

Salary. Your gross income for the current year.
Spouse's salary. Spouse's income for the current year.
Bonuses. Amount of bonus.
Dividends. Amount of dividends paid per year.
Interest. Amount of interest earned per year.
Social Security. Amount of monthly benefits.
Disability. Amount of monthly benefits.
Pensions. Amount of monthly benefits.
Rental income. Amount per year.
Capital gains. Amount

10. Estimate the value of your gross estate. For more information, review the section, Valuing Your Gross Estate.

$0 -- $25,000
$25,001-- $50,000
$50,001 -- $100,000
$100,001 -- $150,000
$150,001 -- $200,000
$200,001 -- $250,000
$250,001 -- $300,000
$300,001 -- $350,000
$350,001 -- $400,000
$400,001 -- $450,000
$450,001 -- $500,000
$500,001 -- $550,000
$550,001 -- $600,000
$600,001 -- $650,000
$650,001 -- $700,000
$700,001 -- $750,000
$750,001 -- $800,000
$800,001 -- $850,000
$850,001 -- $900,000
$900,001 -- $950,000
$950,001 -- $1,000,000
$1,000,001 -- $1,500,000
$1,500,001 -- $2,000,000
$2,000,001 -- $2,500,000
$2,500,001 -- $3,000,000
$3,000,001 -- $3,500,000
$3,500,001 -- $4,000,000
$4,000,001 -- $4,500,000
$4,500,001 -- $5,000,000
$5,000,001 -- $5,500,000
$5,500,001 -- $6,000,000
$6,000,001 -- $6,500,000
$6,500,001 -- $7,000,000
$7,000,001 -- $7,500,000
$7,500,001 -- $8,000,000
$8,000,001 -- $8,500,000
$8,500,001 -- $9,000,000
$9,000,001 -- $9,500,000
$9,500,001 -- $10,000,000
More than $10,000,000

Note: Clicking Reset will erase the information up to the previous Reset button.

Please print the complete form and provide a copy to your attorney.

---

Prepared by Carol A. Schwab, J.D., LL.M.,
Professor and Extension Specialist, NC State University.

This publication is provided as a public service and is designed to acquaint you with certain legal issues and concerns. It is not designed as a substitute for legal advice, nor does it tell you everything you may need to know about this subject. Future changes in the law cannot be predicted, and statements in this publication are based solely on the laws in force on the date of publication.

WARNING: This questionnaire is designed to help your attorney prepare the appropriate legal document. Providing answers to the questionnaire has no legal effect and is not a substitute for the legal document itself.

Date: August 2000