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Dutton & Casey Planning Questionnaire

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Fields marked with a * are required

TO AVOID ANY CONFUSION, IF YOU ARE COMPLETING THIS FORM FOR SOMEONE ELSE, PLEASE PROVIDE INFORMATION PERTAINING TO THEM IN THE SPACES BELOW.


The purpose of this questionnaire is to gather information before your consultation so that it is readily available for the attorney when you meet. This will maximize your time with the attorney, as more of your time can be spent discussing possible solutions and next steps. Please do not be concerned if you cannot complete all of the questions, as we recognize that you may not have access to all of this information.

If yes, please indicate the branch and the years served:

If yes, please indicate the branch and the years served:

If applicable, please list any other children prior to the marriage / union:

Please list other persons who are important to your estate plan (grandchildren, siblings, nieces, etc.):

(If yes, please bring a copy of your power of attorney for property to your meeting.)

(If yes, please bring a copy of your power of attorney for healthcare to your meeting.)

Please list your estimated MONTHLY income from the following sources:

Social Security:

Bank Interest:

Dividends:

Veteran Benefits:

Employment:

Rental Income:

Other Income:

Pension*:

*Gross pension amount, including any monies taken out for federal income taxes, health insurance, or any other reason.

(Please divide annual expenses by 12 and quarterly expenses by 3)

Complete the appropriate sections or attach separate statements such as bank account or brokerage statements, balance sheets, your own list, etc. Spouse / partner: if assets are not owned jointly, please indicate.

1. Real Estate

2. Real Estate

Individual Companies

Brokerage Accounts

Bank Accounts

Promissory Notes, Mortgages (money owed to you)

Tangible Personal Property




Life Insurance

Prepaid Burial Plan and Cemetery Plots

Retirement Benefits

(a) IRA Accounts, 401K, 403B

(b) Annuities

Business Assets

Other items of special value which should be considered in planning your estate:

Do you have any assets with a basis significantly lower than present value? For example, did you purchase your house, stocks, or other assets many years ago for a price significantly more / less than what they are worth now? If so, please describe the assets:

Are you or your spouse / partner the beneficiary of any trusts?

If yes, please list the gift(s) below:

Type of Asset: Residence

Type of Asset: Real Estate (other than residence)

Type of Asset: Stocks and Bonds

Type of Asset: Bank Accounts

Type of Asset: Mortgages

Type of Asset: Life Insurance

Type of Asset: Business Assets

Type of Asset: Annuities

Type of Asset: Vehicle (1)

Type of Asset: Vehicle (2)

Type of Asset: IRA's

Type of Asset: Retirement Funds

Type of Asset: Other

Relevant Documents

Please bring the following documents (or any other documents you deem relevant) to our meeting, if available:

  • Will(s)
  • Deed to Residence
  • Latest Tax Returns
  • Insurance Policies
  • Bank or Brokerage Account Statements
  • Powers of Attorney
  • Trust Documents
  • Health Insurance Policies
  • Social Security Award Letters
  • Pension Statements

Referral Source:

We look forward to learning more about your legal concerns and discussing how we can best assist you. If you have any questions as you prepare for your meeting, please do not hesitate to contact our office at 312-899-0950, or 847-261-4708 or www.duttonelderlaw.com.