Property Questionnaire What Are Your Assets? Cash and Bank Accounts Individual accounts can be left by will; joint tenancy and payable-on-death accounts cannot Checking Account ...................................................................................$_____________ Bank ____________________________________________________________________ Account number ___________________________________________________________ Name(s)on account _________________________________________________________ Checking Account ...................................................................................$_____________ Bank____________________________________________________________________ Account number __________________________________________________________ Name(s)on account ________________________________________________________ Savings Account ......................................................................................$_____________ Bank_____________________________________________________________________ Account number ___________________________________________________________ Name(s)on account ________________________________________________________ Savings Account ......................................................................................$_____________ Bank_________________________________________________________________________ Account number ___________________________________________________________ Name(s)on account ________________________________________________________ Certificate of Deposit ..............................................................................$_____________ Held by___________________________________________________________________ Expiration date ____________________________________________________________ Name(s)on account ________________________________________________________ Other Account .........................................................................................$_____________ Bank_____________________________________________________________________ Account number ___________________________________________________________ Name(s)on account ________________________________________________________ Total Cash and Bank Accounts ........................................................(A)$_____________ Life Insurance and Annuity Contracts Life insurance benefits cannot be left by will. Ordinary Life ..........................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Ordinary Life ..........................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Endowment .............................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term Life ................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term Life ................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Annuity Contract .....................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Policy number ____________________________________________________________ Beneficiary _______________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Total Insurance and Annuity Contracts ...........................................(B)$_____________ Accounts and Notes Receivable Debts payable to you may be left by will Accounts Receivable ...............................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Accounts Receivable ...............................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Accounts Receivable ...............................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Notes Receivable ....................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Notes Receivable ....................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Notes Receivable ....................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Other Debts .............................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Other Debts .............................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Other Debts .............................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Other Debts .............................................................................................$_____________ Due from ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Total Accounts and Notes Receivable ..............................................(C)$_____________ Stocks and Mutual Funds Ownership of individually-held stock and mutual funds may be left by will Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Total Stocks and Mutual Funds ........................................................(D)$_____________ Bonds and Mutual Bond Funds Ownership of individually-held bonds and mutual bond funds may be left by will Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ CUSIP or certificate number _________________________________________________ Number and type of shares __________________________________________________ Value .......................................................................................................$_____________ Total Bonds and Mutual Bond Funds ..............................................(E)$_____________ Business Interests Ownership of business interests may generally be left by will Individual Proprietorship Name_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Type of business ___________________________________________________________ Your net value .........................................................................................$_____________ Individual Proprietorship Name_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Type of business ___________________________________________________________ Your net value .........................................................................................$_____________ Interest in Partnership Name_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Type of business ___________________________________________________________ Gross value ..............................................................................................$_____________ Percentage interest (enter as decimal) _____________ Your net value .........................................................................................$_____________ Interest in Partnership Name_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Type of business ___________________________________________________________ Gross value ..............................................................................................$_____________ Percentage interest (enter as decimal) _____________ Your net value .........................................................................................$_____________ Closely-held Corporation Interest Name_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Type of business ___________________________________________________________ Gross value ..............................................................................................$_____________ Percentage of shares held (enter as decimal) _____________ Your net value .........................................................................................$_____________ Total Business Interests .....................................................................(F)$_____________ Real Estate Property owned individually or as tenants-in-common may be left by will. Property held in joint tenancy or tenancy-by-entirety may not Personal Residence Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Value .......................................................................................................$_____________ How is property held (joint tenants, tenancy-in-common, etc.)?______________________ What is your percent?(Enter as decimal) _____________ Value of your share .................................................................................$_____________ Vacation Home Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Value .......................................................................................................$_____________ How is property held (joint tenants, tenancy-in-common, etc.)?______________________ What is your percent?(Enter as decimal) _____________ Value of your share .................................................................................$_____________ Vacant Land Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Value .......................................................................................................$_____________ How is property held (joint tenants, tenancy-in-common, etc.)?______________________ What is your percent?(Enter as decimal) _____________ Value of your share .................................................................................$_____________ Income Property Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Value .......................................................................................................$_____________ How is property held (joint tenants, tenancy-in-common, etc.)?______________________ What is your percent?(Enter as decimal) _____________ Value of your share .................................................................................$_____________ Other Property Location______________________________________________________________________ ______________________________________________________________________________ _____________________________________________ Value .......................................................................................................$_____________ How is property held (joint tenants, tenancy-in-common, etc.)?______________________ What is your percent?(Enter as decimal) _____________ Value of your share .................................................................................$_____________ Total Real Estate ..............................................................................(G)$_____________ Personal Property Personal property owned individually or as a tenant-in-common may be left by will Car ...........................................................................................................$_____________ Description _______________________________________________________________ Car ...........................................................................................................$_____________ Description _______________________________________________________________ Boat .........................................................................................................$_____________ Description _______________________________________________________________ Other Vehicle ..........................................................................................$_____________ Description _______________________________________________________________ Furniture ..................................................................................................$_____________ Description _______________________________________________________________ Furniture ..................................................................................................$_____________ Description _______________________________________________________________ Furniture ..................................................................................................$_____________ Description _______________________________________________________________ Appliance ................................................................................................$_____________ Description _______________________________________________________________ Jewelry and Furs .....................................................................................$_____________ Description _______________________________________________________________ Music System ..........................................................................................$_____________ Description _______________________________________________________________ Artwork ...................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Total Personal Property ...................................................................(H)$_____________ Miscellaneous Assets Royalties .................................................................................................$_____________ Description _______________________________________________________________ Royalties .................................................................................................$_____________ Description _______________________________________________________________ Patents .....................................................................................................$_____________ Description _______________________________________________________________ Copyrights ...............................................................................................$_____________ Description _______________________________________________________________ Heirlooms ................................................................................................$_____________ Description _______________________________________________________________ Heirlooms ................................................................................................$_____________ Description _______________________________________________________________ Heirlooms ................................................................................................$_____________ Description _______________________________________________________________ Heirlooms ................................................................................................$_____________ Description _______________________________________________________________ Heirlooms ................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Other .......................................................................................................$_____________ Description _______________________________________________________________ Total Miscellaneous Assets ................................................................(I)$_____________ Employee Benefit and Pension/Profit-sharing Plans Retirement benefits cannot be left by will Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Plan type ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Net value .................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Plan type ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Net value .................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Plan type ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Net value .................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Plan type ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Net value .................................................................................................$_____________ Company______________________________________________________________________ ______________________________________________________________________________ ___________________________________________ Plan type ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Net value .................................................................................................$_____________ Total Employee Benefit and Pension/Profit-sharing Plans ...............(J)$_____________ Total Assets Insert totals from previous pages. Cash and Bank Accounts Total .........................................................(A)$_____________ Insurance and Annuity Contracts Total .............................................(B)$_____________ Accounts and Notes Receivable Total ...............................................(C)$_____________ Stocks and Mutual Funds Total ........................................................(D)$_____________ Bonds and Mutual Fund Bonds Total ................................................(E)$_____________ Business Interests Total .....................................................................(F)$_____________ Real Estate Total ...............................................................................(G)$_____________ Personal Property Total .....................................................................(H)$_____________ Miscellaneous Assets Total ................................................................(I)$_____________ Employee Benefit and Pension/Profit-sharing Plans Total ...................(J)$_____________ Total Assets .......................................................................................(1)$_____________ What Are Your Liabilities? Notes and Loans Payable Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Total Notes and Loans Payable .......................................................(K)$_____________ Accounts Payable Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Total Accounts Payable ....................................................................(L)$_____________ Mortgages Payable Property Location __________________________________________________________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Property Location __________________________________________________________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Property Location __________________________________________________________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Property Location __________________________________________________________ Payable to ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Total Mortgages Payable ................................................................(M)$_____________ Taxes Payable Federal Income Taxes .............................................................................$_____________ State Income Taxes .................................................................................$_____________ Personal Property Taxes ..........................................................................$_____________ Real Estate Taxes ....................................................................................$_____________ Payroll Taxes ...........................................................................................$_____________ Other Taxes .............................................................................................$_____________ Other Taxes .............................................................................................$_____________ Other Taxes .............................................................................................$_____________ Total Taxes Payable ...........................................................................(N)$_____________ Credit Card Accounts Payable Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Credit Card Company ______________________________________________________ Credit card account number __________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Total Credit Card Accounts Payable ................................................(O)$_____________ Miscellaneous Liabilities Payable To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ To Whom Due ____________________________________________________________ Address_______________________________________________________________________ ______________________________________________________________________________ ____________________________________________ Term_________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Interest rate __________% Amount due .............................................................................................$_____________ Total Miscellaneous Liabilities Payable ...........................................(P)$_____________ Total Liabilities Insert totals from previous pages Notes and Loans Payable Total .........................................................(K)$_____________ Accounts Payable Total .....................................................................(L)$_____________ Mortgages Payable Total ..................................................................(M)$_____________ Taxes Payable Total ..........................................................................(N)$_____________ Credit Card Accounts Payable Total ..................................................(O)$_____________ Miscellaneous Liabilities Payable Total ..............................................(P)$_____________ Total Liabilities .................................................................................(2)$_____________ Net Worth Of Your Estate Total Assets .......................................................................................(1)$_____________ Minus (-)Total Liabilities ...................................................................(2)$_____________ Equals (=)Your Total Net Worth ..........................................................$_____________