Call Today at (215) 570-0047

Supplemental Estate Planning Questionnaire

Supplemental Estate Planning Questionnaire

For Parents with Special Needs Children over the age of eighteen (18) years old.

Child Information

First Name

Middle Name

Last Name

Child Birth Date

Address Line 1

Address Line 2

City

State

Zip Code

Financial General Power of Attorney

Agent or Co-Agent

First Choice

Second Choice

If more than one Agent is selected, may either Agent act alone, independent of the other Agent, or must all Co-Agents act together?

Act Alone

Act Together

Health Care Power of Attorney & Living Will

Agent or Co-Agent

First Choice

Second Choice

If more than one Agent is selected, may either Agent act alone, independent of the other Agent, or must all Co-Agents act together?

Act Alone

Act Together

Assets and Liabilities

Bank Accounts - We require copies of Statements

Amount	Ownership

Real Estate: Residence - We require copy of deed

Amount	Ownership

Real Estate: Other- We require copy of deed

Amount	Ownership

Savings Certificates - We require copies of statements

Amount	Ownership

Stocks: Non Mutual Funds Held by Broker - We require copies of statements

Amount	Ownership

Stocks: Non Mutual Funds NOT Held by Broker - We require copies of statements

Amount	Ownership

Bonds: Non Mutual Funds Held by Broker - We require copies of statements

Amount	Ownership

Bonds: Non Mutual Funds NOT Held by Broker - We require copies of statements

Amount	Ownership

Mutual Funds - We require copies of statements

Amount	Ownership

Note and Mortgage Receivables - We require Copies of Notes and Mortgages

Amount	Ownership

Business Interests - We require copies of stock certificates, partnership agreements, and/or other documentation.

Amount	Ownership

Inheritance, etc.

Amount	Ownership

Automobiles

Amount	Ownership

Jewelry and Collections listed on Insurance

Amount	Ownership

Non-IRA Tax Qualified Retirement Plans - We require statements

Amount	Ownership

IRA's - We require statements

Amount	Ownership

Life Insurance - We require copies of All Policies

Amount	Ownership

Annuities - We require copies of All Policies

Amount	Ownership

Other Assets- We require copies of relevant documents

Amount	Ownership

Client Information

First Name

Last Name

What is your email? The completed form will be sent to this address.

What is your phone number?

Submitting this form generates a PDF document that will be emailed to our office. A copy of the document will be sent to the email you provided above. Please wait until you see a confirmation message appear before exiting this page.

Office Location

600 Eagleview Blvd.
Suite 300 (3rd Floor)
Exton, PA 19341

For Parking: Please pull around to the front of the building, which is located at the lower section of the parking lot by gazebo and Handicap parking spaces.

With nearly three decades of experience in our field, we put our clients and their families needs first.

Complimentary initial consultation and annual review are included.

rsteenlaw@gmail.com

© Law Offices of Randy Hope Steen, LTD. All Rights Reserved.