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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: _____________________________________________ Owners ¾Form 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
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