<p> Form 14-7 ESTATE PLANNING QUESTIONNAIRE CONFIDENTIAL</p><p>Date: ______Name, File No. ______</p><p>Section I______Page | 1</p><p>CLIENT SPOUSE</p><p>Full Name: Full Name:</p><p>______</p><p>Social Security No: ______Social Security No: ______</p><p>Date of Birth: ______Date of Birth: ______</p><p>Citizenship: ______Citizenship: ______</p><p>Occupation: ______Occupation: ______</p><p>Employer: ______Employer: ______</p><p>Business Address: ______Business Address: ______</p><p>______</p><p>______</p><p>Tel (work):______Tel (work): ______</p><p>Status of Health: ______Status of Health: ______</p><p>Home Address: ______Other Address: ______</p><p>______</p><p>______</p><p>County of Residence: ______County of Residence: ______</p><p>Tel (home): ______Tel (home): ______</p><p>Tel (cell): ______Tel (cell): ______email: ______email: ______1 e g a P Law Office of Marcia E. Anderson, LLC Section II______</p><p>CHILDREN/GRANDCHILDREN Indicate if by previous marriage by writing PM before name; use two lines if needed: Page | 2 Name Birth Sex Soc Sec No. Home Address* Date M/F ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>*If not living at home</p><p>Section III______</p><p>BACKGROUND INFORMATION List any person from whom client or spouse may receive a significant inheritance or distribution from a trust: Benefactor Description (include Estimated V alue estimated date)</p><p>______</p><p>______</p><p>______</p><p>If a previous marriage ended in divorce, describe the resulting obligations under the divorce decree, or attach a copy of the decree or any agreement:</p><p>______</p><p>______</p><p>______1 e g a P Law Office of Marcia E. Anderson, LLC Describe any ante- nuptial agreement between client and spouse or attach a copy of the agreement:</p><p>______</p><p>______</p><p>Section IV______Page | 3</p><p>PRIOR TRANSFERS * List any prior transfers which exceeded the annual gift tax exclusion, including outright gifts and revocable or irrevocable trusts: Type of Date Transfer Recipient Amount ______</p><p>______</p><p>______</p><p>______</p><p>* Through December 31, 1983, the annual gift tax exclusion was $3,000. After that date, the exclusion was increased to $10,000 annually and, in 1997, indexed for inflation (currently $11,000). Where spouses agree to split gifts as donors, the exclusion amounts are doubled.</p><p>NOTE: Include in the above schedule any gifts to charity. List any charitable organization to be benefite d through a lifetime or testamentary gift: ______</p><p>______</p><p>______</p><p>Section V______</p><p>LIFE INSURANCE List current beneficiaries: Policy No. Insurance Co. Owner Beneficiary Face Amount</p><p>______</p><p>______1 e g</p><p>______a P Law Office of Marcia E. Anderson, LLC ______</p><p>______</p><p>______Page | 4 Section VI ______STATEMENT OF FINANCIAL CONDITION ASSETS Husband Wife Joint Cash Equivalents Checking accounts $ ______</p><p>Savings accounts ______Money market fund accounts ______Certificates of deposit ______U.S. Treasury bills ______Death benefits of life insurance (with cash value of life insurance) ______</p><p>Employer group life insurance ______</p><p>Investments Stocks ______Bonds ______Mutual fund investments ______Partnership interests ______Other investments ______</p><p>Retirement Funds Pension (present lump-sum value) ______Joint and survivor annuities ______IRAs and Keogh accounts ______Employee savings plans (e.g., 401(k)) ______</p><p>Personal Assets Principal residence ______1</p><p>Second residence ______e g a P Law Office of Marcia E. Anderson, LLC Collectibles/art/antiques ______Automobiles ______Home furnishings ______</p><p>Furs and jewelry ______Page | 5</p><p>Other assets ______</p><p>Total assets ______LIABILITIES Husband Wife Joint Charg e account balance ______Personal loans ______Investment loans (margin, real estate, etc.) ______</p><p>Home mortgages ______Home equity loans ______Life insurance policy loans ______Projected income tax liability ______</p><p>Total liabilities ______</p><p>Section VII______ADVISORS List name, firm, address and telephone:</p><p>Accountant: Telephone ______(___)______Banking Contact: ______(___)______</p><p>______1 e g a P Law Office of Marcia E. Anderson, LLC ______Investment Advisor/Stockbroker: ______(___)______</p><p>______Page | 6 ______Life Insurance Agent: ______(___)______Physician: ______(___)______Other: ______(___)______</p><p>Section VIII______LOCATIONS OF IMPORTANT DOCUMENTS AND OTHER INFORMATION Item Location Wills and codicils: ______Divorce decrees, separation agreements, prenuptial agreements: ______</p><p>Life insurance policies: ______Stocks and bonds: ______Notes or mortgages receivable: ______Deeds: ______Bank books and financial records: ______Income tax returns and gift tax returns, 1 e</p><p> federal and state: ______g a P Law Office of Marcia E. Anderson, LLC Trust instruments: ______Closely-held corporation buy-sell agreement: ______Page | 7 Safe deposit boxes: ______Other: ______</p><p>Section IX______DESIGNATION OF PERSONAL REPRESENTATIVES Full Name Relationship to Client Contact Information</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>DESIGNATION OF GUARDIANS</p><p>Full Name Relationship to Client Contact Information ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>DESIGNATION OF TRUSTEES 1 e g a P Law Office of Marcia E. Anderson, LLC Full Name Relationship to Client Contact Information ______</p><p>______</p><p>______Page | 8</p><p>______</p><p>______</p><p>______1 e g a P Law Office of Marcia E. Anderson, LLC</p>