Questionnaire (Individual) - Robert T. Napier

Step 1 of 3

33%

Your Information

Legal Name(Required)

Prefix First Middle Last Suffix

Nickname

Address(Required)

Street Address Address Line 2 City State / Province ZIP Code

Home Phone

Work Phone

Work Phone Extension

Cell Phone(Required)

Email(Required)

Date of Birth

MM slash DD slash YYYY

Occupation

Job Title

Employer

Estimated Annual Income

Please enter a number from 0 to 99999999999.

Are you a U.S. citizen?(Required)

Yes

In what state are you domiciled?(Required)

Are you healthy?

Yes

Please explain:

Additional Information

Do you currently have a revocable living trust in existence?(Required)

Yes

Do you own any property in a land trust?

Yes

Do you have an umbrella insurance policy?

Yes

Who is your insurance carrier?

What is your coverage limit?

Please enter a number from 0 to 99999999999.

Are you subject to a divorce decree?

Yes

Are there any pending or threatened claims or suits against you?

Yes

Are you a trustee, director, fiduciary, or retirement/investment plan administrator?

Yes

Other than tax savings, what are your estate planning goals?

Where is your safe deposit box located? (Leave blank if not applicable.)

Do you have children?(Required)

Yes

Please enter your children below.

Child 1 Name(Required)

Child 1 Age(Required)

Child 1 Marital Status

Married

Single

Child 2 Name

Child 2 Age

Child 2 Marital Status

Married

Single

Child 3 Name

Child 3 Age

Child 3 Marital Status

Married

Single

Child 4 Name

Child 4 Age

Child 4 Marital Status

Married

Single

Child 5 Name

Child 5 Age

Child 5 Marital Status

Married

Single

If you have minor children, who would act as their guardian if you could not? (Also, please name a successor guardian if you can.)

Who would make medical decisions for you in the event you could not make them for yourself? Please name a successor if the first person you choose cannot act.

Where would you have your assets go in the event of a catastrophe in which your nuclear family was lost?

Please specify:(Required)

Do you anticipate an inheritance?

Yes

Have you ever lived in a community property state (CA, WI, AZ, NM, TX, etc.)?

Yes

Have you ever filed a gift tax return?

Yes

Are you a beneficiary of any trust?

Yes

Are you charitably inclined?

Yes

Maybe

Please elaborate:

Accountant Name

Accountant Phone

Extension

Financial Advisor Name

Financial Advisor Phone

Extension

Financial Advisor Institution

Do you know of any other clients of Robert T. Napier or the firm?

Balance Sheet

THIS QUESTIONNAIRE IS INTENDED TO SUPPLY OVERVIEW INFORMATION ONLY.
REMINDER: Bring your existing estate planning documents, if available.

Assets

Please do not include "$" signs, commas, or cents.

Home

Home(Required)

Please enter a number from 0 to 99999999999.

Other Real Estate

Other Real Estate(Required)

Please enter a number from 0 to 99999999999.

Stocks, Bonds

Stocks, Bonds(Required)

Please enter a number from 0 to 99999999999.

401(k), Keogh, etc.

401(k), Keogh, etc.(Required)

Please enter a number from 0 to 99999999999.

IRA

IRA(Required)

Please enter a number from 0 to 99999999999.

Roth IRA

Roth IRA(Required)

Please enter a number from 0 to 99999999999.

Private Placements

Private Placements(Required)

Please enter a number from 0 to 99999999999.

Cash

Cash(Required)

Please enter a number from 0 to 99999999999.

Insurance - Death Benefit

Insurance - Death Benefit(Required)

Please enter a number from 0 to 99999999999.

Business Interests

Business Interests(Required)

Please enter a number from 0 to 99999999999.

Notes Receivable

Notes Receivable(Required)

Please enter a number from 0 to 99999999999.

Other

Other Assets(Required)

Please enter a number from 0 to 99999999999.

Total Assets

Total Assets(Required)

Liabilities

Please do not include "$" signs, commas, or cents.

Debts

Debts(Required)

Please enter a number from 0 to 99999999999.

Mortgage(s) on Home

Mortgage(s) on Home(Required)

Please enter a number from 0 to 99999999999.

Other

Other Liabilities(Required)

Please enter a number from 0 to 99999999999.

Total Liabilities

Total Liabilities(Required)

How did you learn of us?(Required)

Acknowledgement(Required)

I have reviewed this form, and I am ready to submit. I understand that an attorney/client relationship is not created by submitting the questionnaire.

Phone

This field is for validation purposes and should be left unchanged.