Client Estate Planning Form (Page 4 of 7) in pdf

M. G

FFICE OF

AVID

OLDMAN

Your and Your Spouse’s Health

Please describe any serious health conditions:

______________________________________________________________________________

Income

Please list all sources of regular or expected income, with brief explanation and

approximate monthly amount.

You: _______________________________________________________________________

____________________________________________________________________________

Spouse: ____________________________________________________________________

____________________________________________________________________________

Assets

Please list the name of the institution in which you have any of the following

accounts. Please indicate the name of anyone who is a joint holder of each account,

the approximate value of each account and any named beneficiary (such as PoD):

Checking Accounts: _______________________________________________________

_________________________________________________________________________

Savings/Money Market Accounts: __________________________________________

__________________________________________________________________________

Retirement Accounts: _____________________________________________________

__________________________________________________________________________

Investment or Brokerage accounts:_________________________________________

__________________________________________________________________________

Annuities: ________________________________________________________________

Other Accounts: __________________________________________________________

__________________________________________________________________________

Do you own stocks or bonds that are not managed by an institution? Yes

If yes, please describe including approximate value: ____________________________

____________________________________________________________________________

Email: , Phone: 410-205-4830, Secure Fax: 602-424-0103

Client Estate Planning Form Page 4