318-C Diablo Road
Danville, CA 94526
Tel: 925. 314.9999
Fax: 925. 314.9960

Barr and Barr - Estate Planning

Estate Planning Information Form

To begin the estate planning process, please complete our Estate Planning Information Form.  After completing the form, please send it to us by email, fax, regular mail, or by completing this online form.  We will then contact you to schedule an appointment.

Transmission of the information is not intended to create, and receipt does not constitute, an attorney-client relationship.

 

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Contact Information

Your Name*:
Your Birthdate:
Your Spouse's Name:
Your Spouse's Birthdate:
Mailing Address1*:
City:
State:
Zip Code:
Home Phone*:
Work Phone:
Mobile Phone:
Email*:

Marriage Information

Marriage Date:
Place of Marriage:
Prior Marriages?
• Husband — yes no 
• Wife — yes no 
Are you and your spouse U.S. Citizens? yes no 

Children

Child 1:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Child 2:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Child 3:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Child 4:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Child 5:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Child 6:

Name:
Birthdate:
Residence City/State:
Marital Status:
From Prior Marriage? yes no 
Deceased? yes no 

Employment Information

Occupation (his):
Occupation (hers):

Real Estate Assets

Please list each piece of real property by address, description (i.e. primary residence, secondary residence, land, vacation home, rental property, commercial property) and asset value.

Asset 1:

Address:
Description:
Value:

Asset 2:

Address:
Description:
Value:

Asset 3:

Address:
Description:
Value:

Asset 4:

Address:
Description:
Value:

Asset 5:

Address:
Description:
Value:

Asset 6:

Address:
Description:
Value:

Bank Accounts

Please list by Bank and Account Number, type (i.e. checking, savings, CD, money market) and value.

Account 1:

Bank:
Account Number:
Type:
Value:

Account 2:

Bank:
Account Number:
Type:
Value:

Account 3:

Bank:
Account Number:
Type:
Value:

Account 4:

Bank:
Account Number:
Type:
Value:

Account 5:

Bank:
Account Number:
Type:
Value:

Account 6:

Bank:
Account Number:
Type:
Value:

Investment Assets

Please list by Bank/Broker and Account Number, type (i.e. bonds, common stock, mutual fund, Ltd. Partnership, preferred stock, etc.) and value.

Account 1:

Bank/Broker:
Account Number:
Type:
Value:

Account 2:

Bank/Broker:
Account Number:
Description:
Value:

Account 3:

Bank/Broker:
Account Number:
Type:
Value:

Account 4:

Bank/Broker:
Account Number:
Type:
Value:

Account 5:

Bank/Broker:
Account Number:
Type:
Value:

Account 6:

Bank/Broker:
Account Number:
Type:
Value:

Retirement Assets

Please list by Bank/Broker and Account Number, type (i.e. 401k, 403b, IRA, Qualified Plan, SEP/IRA, etc.) and value.

Account 1:

Bank/Broker:
Account Number:
Type:
Value:

Account 2:

Bank/Broker:
Account Number:
Type:
Value:

Account 3:

Bank/Broker:
Account Number:
Type:
Value:

Account 4:

Bank/Broker:
Account Number:
Type:
Value:

Account 5:

Bank/Broker:
Account Number:
Type:
Value:

Account 6:

Bank/Broker:
Account Number:
Type:
Value:

Insurance Assets

Please list by Insurance Company and Policy Number, type (i.e. term policy, whole life policy, universal life policy, variable life policy) and value.

Account 1:

Insurance Company:
Policy Number:
Type:
Value:

Account 2:

Insurance Company:
Policy Number:
Type:
Value:

Account 3:

Insurance Company:
Policy Number:
Type:
Value:

Account 4:

Insurance Company:
Policy Number:
Type:
Value:

Account 5:

Insurance Company:
Policy Number:
Type:
Value:

Account 6:

Insurance Company:
Policy Number:
Type:
Value:

Business Assets

Please list by Name, type (i.e. general partnership, limited partnership, C corporation, S corporation, sole proprietorship, LLC, etc.) and value.

Account 1:

Name of Company:
Type:
Value:

Account 2:

Name of Company:
Type:
Value:

Account 3:

Name of Company:
Type:
Value:

Account 4:

Name of Company:
Type:
Value:

Account 5:

Name of Company:
Type:
Value:

Account 6:

Name of Company:
Type:
Value:

Other Assets

Please list other assets of significant value by type (i.e. boats, collectibles, automobiles, etc.) and value.

Account 1:

Type:
Value:

Account 2:

Type:
Value:

Account 3:

Type:
Value:

Account 4:

Type:
Value:

Account 5:

Type:
Value:

Account 6:

Type:
Value:

Liabilities

Please list all debts and liabilities by type (i.e. mortgage, credit line, personal loan, other loan, etc.) and amount.

Account 1:

Type:
Value:

Account 2:

Type:
Value:

Account 3:

Type:
Value:

Account 4:

Type:
Value:

Account 5:

Type:
Value:

Account 6:

Type:
Value:

Previous Estate Planning

Do you currently have a will or trust? yes no 

Has your will or trust ever been amended? yes no 

Who referred you to our office?

Is there anything else you would like us to be aware of before we meet to discuss your estate planning?