ASSET
INVENTORY
Bank Name and Address Form of Account
Account Number (Joint,
Tentative Trust, etc.) Amount
Names of Account
_________________________ ____________________ $_____________
_________________________ ____________________ $_____________
_________________________ ____________________ $_____________
_________________________ ____________________ $_____________
_________________________ ____________________ $_____________
Total: $_____________
Enter here information pertinent to estate planning
decisions:
______________________________________________________________________
______________________________________________________________________
Are these permanent savings accounts or suspense
accounts pending use of funds for other purposes?
______________________________________________________________________
______________________________________________________________________
U.S.
SAVINGS BONDS
Registration of Bonds Total
Redemption Value of Issue Dates
(Form and Names) Bonds So Registered
___________________ _________________ ______________
___________________ _________________ ______________
___________________ _________________ ______________
Total:
__________________
Enter
here information pertinent to estate planning decisions:
______________________________________________________________________
______________________________________________________________________
What
amounts were contributed by each co-owner?
______________________________________________________________________
______________________________________________________________________
OTHER
BONDS
Description Cost
(Issuer or
Series, Rate, Registration of Bonds Face Other Current
Date Acquired) (form and Names) Amount Basis Value
______________ __________________ $__________ ________ $_____________
______________ __________________ $__________ ________ $_____________
______________ __________________ $__________ ________ $_____________
______________ __________________ $__________ ________ $_____________
______________ __________________ $__________ ________ $_____________
______________ __________________ $__________ ________ $_____________
BOND TOTAL: $_________ TOTAL: $_____________
Enter here information pertinent to estate planning
decisions:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
What amounts were contributed by each joint owner?
____________________________________________________________________________
____________________________________________________________________________
Any U.S. Treasury bonds redeemable at par to pay
Federal Estate tax?
____________________________________________________________________________
____________________________________________________________________________
STOCKS
Name
of Company and Type of Stock:
___________________________________________
Number
of Shares:
___________________________________________________________
Registration
of Stock (Form and Names):
_________________________________________
Date
Acquired:
______________________________________________________________
Cost
or Other Basis:
__________________________________________________________
Current
Value:
______________________________________________________________
Enter here information pertinent to estate planning
decisions:
____________________________________________________________________________
____________________________________________________________________________
Is
portfolio active or stable?
____________________________________________________________________________
Is
purpose of investment program primarily current income or capital appreciation?
____________________________________________________________________________
____________________________________________________________________________
Do
you have margin account? Cash account?
____________________________________________________________________________
____________________________________________________________________________
What
amounts were contributed by each joint owner of jointly held stock?
____________________________________________________________________________
List
also other property interests in this area such as warrants, etc.
____________________________________________________________________________
List
all brokers with whom you have account or do business.
____________________________________________________________________________
REAL
ESTATE RESIDENCES
Location
Description, Date Acquired:
_____________________________________________
Owners¾Form of Ownership-Interest of Each
Owner: _______________________________
____________________________________________________________________________
Cost
or Other Basis:
___________________________________________________________
Fair
Market Value:
____________________________________________________________
Mortgages
and Other Liens:
_____________________________________________________
Your
Equity:
_________________________________________________________________
TOTAL: __________________________
INSURANCE
ON HOMES
Type
of Insurance Name of Company Policy Number
Expiration Name of
Dates Broker
_______________ ________________ ______________
__________ ___________
_______________ ________________ ______________
__________ ___________
_______________ ________________ ______________
__________ ___________
_______________ ________________ ______________
__________ ___________
_______________ ________________ ______________
__________ ___________
_______________ ________________ ______________ __________ ___________
_______________ ________________ ______________
__________ ___________
Enter
here information pertinent to estate planning decisions:
____________________________________________________________________________
____________________________________________________________________________
What
amounts were contributes by each joint owner?
____________________________________________________________________________
____________________________________________________________________________
Do
you contemplate any sales of above homes in near future?
____________________________________________________________________________
REAL
ESTATE-INVESTMENTS
Owners-Form of Mortgages
Location Ownership-Inter-
Cost or Fair and
Description est of Each
Other Market Other
Your
Date Acq’d Owner
Basis Value Liens Equity
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
TOTAL: _________________
INSURANCE
ON INVESTMENT REALTY
Type
of Insurance Name of Policy Expiration Name of Broker
Company
Number Dates
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
______________ _____________ _____________
_____________ _____________
Enter
here all information pertinent to estate planning decisions:
____________________________________________________________________________
Is
investment realty owned by corporation in which you hold stock?
______________________________________________________________________
If
so, give details concerning corporation and stockholders.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
NON
BUSINESS RECEIVABLES
Debtor Nature of Debt
Security Date
Due Face Amount Current Value
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
___________ ___________ ___________
TOTAL: ___________
Enter
here other pertinent information:
____________________________________________________________________________
List
any surety or accommodation parties regarding any of the above debts; how payable;
names of associates holding interests in receivables, etc.
____________________________________________________________________________
LIFE
INSURANCE
List all policies under which you are the insured.
Present How
will
Name of Type of
Policy Cash Face Proceeds
Company Policy
Number Value Amount Owner Be Paid Beneficiary
__________ _________
_________ _______ ________
_______ _______ _________
__________ _________
_________ _______ ________
_______ _______ _________
__________ _________
_________ _______ ________
_______ _______ _________
__________ _________
_________ _______ ________
_______ _______ _________
__________ _________
_________ _______ ________
_______ _______ _________
__________ _________
_________ _______ ________
_______ _______ _________
_________ _________
TOTALS
Enter
here information pertinent to estate planning decisions:
____________________________________________________________________________
Are
there any loans under policies?
____________________________________________________________________________
Have
any policies been assigned?
____________________________________________________________________________
Should
you reconsider settlement chosen?
___________________________________________________________________________
Do
you own life insurance on lives of others?
If so, give details here including name of insured, face amount of
policy, and present cash value.
____________________________________________________________________________
____________________________________________________________________________
Who
are insurance agents with whom you deal with ?
____________________________________________________________________________
BUSINESS INTERESTS
Name
of Business:
____________________________________________________________
Address
of Business:
__________________________________________________________
Sole
proprietorship: _______
Partnership: _______ Close
Corporation: __________
Nature
of Business enterprise:
___________________________________________________
Names
of Partners Number of Shares or Office Held Duties
or Stockholders Percentage
Interest
__________________ _________________ ________________ ___________
__________________ _________________ ________________ ___________
__________________ _________________ ________________ ___________
__________________ _________________ ________________ ___________
__________________ _________________ ________________ ___________
__________________ _________________ ________________ ___________
Value
of interest in business: _____________________________________
Have
you entered in to any partnership, stockholders’, cross-purchase, or stock
redemption agreement? If so, describe
briefly on this page.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Are
there IRC Sec. 303 stock redemption considerations?
____________________________________________________________________________
Have
you retained voting rights in transferred stock? [IRC Sec. 2036 (b)].
____________________________________________________________________________
If
no agreement presently exists, what are your wishes with regard to business
interests?
____________________________________________________________________________
Enter
on this page information on family members and key men who can operate business
in the event of your death or disability and other facts relating to plans for
retention or disposition of business interest?
____________________________________________________________________________
List
facts relating to capital structure of corporation. Does corporation hold treasury stock? Has all authorized stock been issued, etc.?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
EMPLOYEE
AND RETIREMENT BENEFITS
Employer’s Pension, Profit-sharing or Stock Bonus
Plans
Plan 1 Plan 2 Plan 3
Name
of Plan
_________________ _________________ _________________
Trustee,
Insurance
Company,
or
Administrator
_________________ _________________ _________________
Amount
Contributed
by
Employee _________________
_________________ _________________
Amount
Contributed
by
Employer _________________
_________________ _________________
Retirement
Benefit
_________________
_________________ _________________
Death
Benefit _________________ _________________ _________________
Present
Value of Total
Contributions
_________________ _________________ _________________
Amount
Vested ________________ _________________ _________________
What
are the options available to you? Enter
here information pertinent to selection of options offering you maximum
advantage for your situation, e.g.,
payment of lump sum, payment in installments, payment in company stock, payment
in the form of an annuity.
____________________________________________________________________________
Can
you borrow from plan? What amounts can
you presently withdraw?
___________________________________________________________________________
Retirement Benefit Plans
Are
you contributing to an IRA? If
self-employed -- to a Keogh plan?
____________________________________________________________________________
____________________________________________________________________________
Group Life, Accident, Health, Death Benefit, and
Disability Plans
Plan
1 Plan 2 Plan 3
Name
of Plan __________________ ___________________ ________________
Insurer
of Trustee __________________ ___________________ ________________
Policy
Number __________________ ___________________ ________________
Benefits
__________________ ___________________ ________________
Beneficiary
__________________ ___________________ ________________
Options
Elected __________________ ___________________ ________________
What
other options are available to you?
____________________________________________________________________________
Split-Dollar Life Insurance
Enter
here all information relating to split-dollar life insurance, e.g., name of
company, policy number, form of agreement, face amount, net amount payable to
beneficiary.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Stock Options
Enter
her all pertinent information relating to stock options held by you, e.g.,
option price, number of shares to which options extends, number of shares
already purchased, price at which purchased, present market value per share,
etc.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Deferred Compensation Contract
Date
of execution; provisions for retirement and death benefits.
____________________________________________________________________________
TOTAL
DEATH BENEFITS FROM ALL PLANS
___________________
RIGHTS
UNDER ESTATES AND TRUSTS INCLUDING
POWERS OF APPOINTMENT
Rights and interest of trusts set up by yourself
Date
trust executed:
___________________________________________________________
Name
and address of trustee:
____________________________________________________
Duration
of trust:
_____________________________________________________________
Value
of initial corpus on date of transfer to trustee: _________________________________
Present
market value of total corpus:
______________________________________________
Rights
and interests held by settlor (if none, so state): ________________________________
____________________________________________________________________________
Is
trust revocable?
____________________________________________________________________________
Rights
and interests of other beneficiaries (describe briefly; examine copy of trust
instrument):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Details
on your powers of appointment:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Rights
and interest of your trusts set up by others:
___________________________________
____________________________________________________________________________
Type
of trust: Inter vivos
______________ Testamentary
_____________________
Name
of settlor:
______________________________________________________________
Name
and address of trustee:
____________________________________________________
Date
trust executed if inter vivos:
________________________________________________
Date
will probated if testamentary:
_______________________________________________
Court
having supervision of trust:
________________________________________________
Duration
of trust:
_____________________________________________________________
Present
market value of trust corpus:
______________________________________________
Rights
and interest held by you:
_________________________________________________
Is
trust revocable?
____________________________________________________________
Rights
and interests of other beneficiaries:
_________________________________________
____________________________________________________________________________
Details
on your power of appointment: ___________________________________________
____________________________________________________________________________
MISCELLANEOUS
ASSETS
Personal Property
(Automobiles, boats, jewelry, furs, silverware,
china, art works, books, stamp collections, coin collections, household
furniture, etc.)
Description Location
Current Value Costs
or Insurance
Date Acquired Other Basis Information
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
______________ ____________ ____________
___________
_______________
SUBTOTAL: ____________
Patents, Copyrights, Trademarks
Enter
here information pertinent to estate planning decisions, e.g.,
annual
income over last few years, anticipated income to expiration date, etc.
____________________________________________________________________________
____________________________________________________________________________
Oil and Gas Interest
List
all transfers that might be included in gross estate (gifts where donor
retained some control, transfers for inadequate consideration, etc.). Examine copies of all gift tax returns:
How
much unified credit remains for you and your spouse?
____________________________________________________________________________
____________________________________________________________________________
Rights Under Estates Being Administered and Anticipated
Inheritances
Enter
here all pertinent information:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Safe Deposit Boxes
Name
of safe deposit company, address, box number, names and addresses of persons
having access, form of registration. Is
property of any person in box?
____________________________________________________________________________
____________________________________________________________________________
Cemetery Plots
Enter
here all information relating to ownership of family burial plots, location of
deed.
____________________________________________________________________________
____________________________________________________________________________
Other Assets Not Previously Listed
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
TOTAL
- MISCELLANEOUS ASSETS: ____________
LIABILITIES
Nature of Creditor Amount Security Location of
Debt Security
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
__________ __________ __________ ________ _______________
TOTAL _____________
SUMMARY
SHEET
Assets
Bank
Accounts: ________________________________
Bonds
(Total U.S. Savings Bonds and others): ________________________________
Stocks:
________________________________
Real
Estate - Residences: ________________________________
Real
Estate - Investments: ________________________________
Non
Business receivables: ________________________________
Life
Insurance on your life: ________________________________
Life
insurance on lives of others: ________________________________
Business
interests: ________________________________
Death
Benefits - Employee and Retirement plans: ________________________________
Rights
under estates and trusts including powers
of
appointment: ________________________________
Miscellaneous
assets: ________________________________
ESTIMATED
GROSS ESTATE TOTAL: ______________________________
***DOCUMENTS
CHECKLIST (to be examined by attorney as required) AND LOCATION-OTHER REQUIRED
INFORMATION***
Document Location
Previous
will or wills: ________________________________
Spouse’s
will: ________________________________
Antenuptial
agreement: ________________________________
Copies
of income and gift tax returns: ________________________________
Birth
Certificates: ________________________________
Marriage
Certificates: ________________________________
Divorce
Decree: ________________________________
Separation
Agreement: ________________________________
Family
Tree: ________________________________
Military
service discharge certificate and
benefits
records: ________________________________
Social
Security number: ________________________________
Person
holding safe deposit keys: ________________________________
Cemetery
deed: ________________________________
Name
and address of insurance agent: ________________________________
Name
and address of stockbroker: ________________________________
Leases:
________________________________
Deeds
of residence and business property: ________________________________
Tax
receipts: ________________________________
Maps,
surveys: ________________________________
Mortgages
and notes owned: ________________________________
Mortgages
and notes owed: ________________________________
Stock
and bond certificates: ________________________________
Bankbooks
and bank statements: ________________________________
Records
of securities purchased and sold: ________________________________
Life
insurance and annuity policies: ________________________________
Fire
and other casualty insurance policies: ________________________________
Health
and accident policies: ________________________________
Partnership
agreement: ________________________________
Stockholders’
agreement: ________________________________
Stock
redemption agreement: ________________________________
Business
continuation agreement: ________________________________
Business
legal and accounting records: ________________________________
Employee
benefit plan booklets, records
agreements,
certificates, account books: ________________________________
Deferred
compensation agreement: ________________________________
Copies
of trust agreements and wills under which
you
have power of appointment and other rights: ________________________________
Trust
instruments in which you are settlor: ________________________________
Bills
of sale and other evidences of ownership: ________________________________
The Asset Inventory Form needs to be used with the Estate
Analysis Form found in the Financial Planning Category
