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Estate Planning Information Form

Date
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Family Information Please include middle initials, any aliases, etc.
Full Name(*)
Please let us know your name.

Date of Birth
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Your Email(*)
Please let us know your email address.

Place of Birth
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Spouse/Partner
Full Name
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Date of Birth
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Place of Birth
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Email
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Address
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Telephone
Home
Please enter a valid phone number (123-456-7890)

Office
Please enter a valid phone number (123-456-7890)

Cell
Please enter a valid phone number (123-456-7890)

Cell
Please enter a valid phone number (123-456-7890)

U.S. Citizen
Husband/Partner
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Wife/Partner
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Children
Full Name
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Address
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Telephone
Please enter a valid phone number (123-456-7890)

Date of Birth
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Marital Status
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Invalid Input

Full Name
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Address
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Telephone
Please enter a valid phone number (123-456-7890)

Date of Birth
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Marital Status
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Invalid Input

Full Name
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Address
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Telephone
Please enter a valid phone number (123-456-7890)

Date of Birth
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Marital Status
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Invalid Input

Full Name
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Address
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Telephone
Please enter a valid phone number (123-456-7890)

Date of Birth
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Marital Status
Invalid Input

Invalid Input

Full Name
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Address
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Telephone
Please enter a valid phone number (123-456-7890)

Date of Birth
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Marital Status
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Children’s Spouses
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Grandchildren
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Husband/Partner’s: Parents, Brothers, Sisters, Others (please identify relationship):
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Wife/Partner’s: Parents, Brothers, Sisters, Others (please identify relationship)
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Do you and/or your spouse/partner have an existing Will and Trust Agreement? If so, please describe
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If you have a burial plot and/or made arrangements for your funeral, please list information below:
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Do you have a beneficiary that has special needs?
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Are you or your spouse/partner the beneficiary of a trust that someone else created for your benefit?
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Do you or your spouse/partner have a power of appointment under a trust that another person created for your benefit?
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Fiduciary Information
Choice of Executor/Co-Executor (please include full name, relationship and address):
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Choice of Successor Executor/Co-Executor (please include full name, relationship and address
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Choice of Trustee/Co-Trustee (please include full name, relationship and address)
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Choice of Successor Trustee/Co-Trustee (please include full name, relationship and address)
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Choice of Guardian/Co-Guardian for minor children, if any (please include full name, relationship and address)
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Choice of Successor Guardian/Co-Guardian for minor children, if any (please include full name, relationship and address)
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Choice of Healthcare Power of Attorney and Alternate Agents (please include full name, relationship, address and telephone numbers)
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Real Estate
Please use these descriptions in the TYPE field(s) for your Real Estate assets.
Primary Residence | Land | Rental Home | Commercial Property | Second Residence | Vacation Home | Rental Property
Type
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Address
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Address
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Address
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Address
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Address
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Bank Account
Please use these descriptions in the TYPE field for your Bank Account assets.
Checking | CD | Savings | Money Market
Type
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Bank/Credit Union Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type
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Bank/Credit Union Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type
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Bank/Credit Union Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type
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Bank/Credit Union Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type
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Bank/Credit Union Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Investment
Please use these descriptions in the TYPE field for your Investment assets.
Bonds | Ltd. Partnership | Preferred Stock | Annuity | Common Stock | Mutual Fund | Stock Brokerage
Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Retirement
Please use these descriptions in the TYPE field for your Retirement assets.
401k | IRA | SEP/IRA | 403b | Qualified Plan | Other
Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Type/Account Number
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Investment Company
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Asset Value
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Insurance
Please use these descriptions in the TYPE field for your Insurance assets.
Term Policy | Universal Life Policy | Whole Life Policy | Variable Life Policy
Type/Account Number
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Life Insurance Company Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Death Benefit
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Type/Account Number
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Life Insurance Company Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Death Benefit
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Type/Account Number
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Life Insurance Company Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Death Benefit
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Type/Account Number
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Life Insurance Company Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Death Benefit
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Type/Account Number
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Life Insurance Company Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Beneficiary
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Death Benefit
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Business
Please use these descriptions in the TYPE field for your Business assets.
General Partnership | C Corporation | Sole Proprietorship | Ltd. Partnership (Bus.) | S Corporation | LLC

PLEASE NOTE IF THERE IS A BUY-SELL AGREEMENT IN EXISTENCE

Type
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Business Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Business Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Business Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Business Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Business Name
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Other
Please use these descriptions in the TYPE field for your other assets.
Collectibles | Recreational | Probable Inheritance | Powers of Attorney | Automobiles | Miscellaneous | Taxable Gifts
Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Type
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Description
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Description
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Asset Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Asset Value
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Liability
Please use these descriptions in the TYPE field for your Liability assets.
Mortgage | Other Loans | Personal Loan
Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Liability Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Liability Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Liability Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Liability Value
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Type
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Description
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Owner (Husband, Wife, Partner, Joint_Owner (Husband, Wife, Partner, Joint)
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Liability Value
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Electronic Access Information
It is important that you should compile a list of all of your electronic login and password information to be kept in a safe place where your family members can access them in case of emergency. Our office does not maintain any of this information.
GENERAL COMMENTS/SPECIAL REQUESTS
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Please take a moment to read the following important information about our privacy policy regarding the handling of your personal information. Protecting your privacy is very important to us.

As part of providing you with the legal services you have requested, we need to obtain pertinent personal information from you. That information includes, but may not be limited to, your address, date of birth, employment status, social security number, income, assets, account numbers, etc.

This information may be collected by telephone, in person, in writing, electronically via the internet or by any other means. It is with this information that we may fulfill and service your needs. We treat the information we gather about you in a confidential manner. The trust of our clients is one of our most valuable assets.

  • Employees of Mignanelli & Associates, Ltd. having access to your personal information are instructed to use strict standards of care regarding the confidentiality of your personal information.
  • We expect persons or organizations that provide services on our behalf to keep client information confidential, using it only to provide the services we have asked them to perform.
  • We do not disclose personal information to anyone, except as may be required by law, or at your direction.

Should your relationship with us end, your personal information will remain protected in accordance with our confidentiality practices as outlined in this privacy notice.

Please feel free to call our office should you have any concerns or questions.

Thank you for your valued business.

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Copyright © 2017 by Mignanelli & Associates, Ltd. All rights reserved. Disclaimer | 10 Weybosset Street Suite 400, Providence, RI 02903
Phone: 401-455-3500 | Fax: 401-455-0648