William G. Witcher, Jr.

Attorney at Law

Estate Planning Worksheet

General Information

Fields marked * are required.

Your Name: * Your E-mail: * Spouse's Full Name: Street Address 1: * Street Address 2: City: * State: * Zip: Home Phone: * Work Phone: County of Residence:

Are both you and your spouse citizens of the United States? Yes No

Family Information

Children: Name, Age, Married?, Address (if living away from home)

Have any of your children died? No Yes

If any of the above children are from a previous marriage, please list their names: Do you have family members with special needs? Do you want to leave any specific items or personal effects to family members or others? It is best to discuss burial instructions with family members. Do you have any wishes, such as cremation, that should be mentioned in your will? Name of proposed guardian for minor children: Street Address 1: Street Address 2: City: State: Zip: Name of possible successor guardian: Street Address 1: Street Address 2: City: State: Zip:

Additional Information Who do you want as Executor of your Will? Age of distribution of trust funds to children (e.g., staggered distributions at ages 25, 30, 35): Who do you want as the Trustee to manage the trust funds? Do you wish to make any special gifts to charities or friends? If so, please list: Do you have a Living Will and Durable Power of Attorney for Health Care? If so, who? Do you have a financial Power of Attorney? If so, who? Do you have a safe deposit box? If so, where? Do you expect to inherit a substantial amount of money from anyone?

Assets

Asset	Husband	Wife	Joint
1. Residence
2. Other Real Property
3. Mortgages
4. Listed or Traded Securities
5. Closely Held and Untraded Securities
6. Partnership or Sole Proprietor Interests
7. Checking Accounts
8. Savings Accounts
9. Retirement Accounts
10. Other Personal Effects
TOTAL GROSS ESTATE
All Debts and Mortgages
TOTAL NET ESTATE
Other Assets
a. Life Insurance

Owner: Company: Face Amount: Beneficiary: Term or Whole Life: Present Cash Value: In case of your death or retirement, would any employer make payments to you or your spouse under any qualified pension or profit-sharing plan, deferred compensation plan, etc.? If so, please describe. Did you contribute to such plans? Who is the beneficiary upon your death?