Estate Planning Questionnaire - Balbach & Davenport

🩵 Estate Planning Questionnaire

BALBACH & DAVENPORT

Legal Counsel | Estate Planning & Family Law

Important Notice: This form does not create an attorney-client relationship. However, if you are a current client or after you establish an attorney-client relationship through a signed engagement agreement, all information provided in this questionnaire is confidential and protected by attorney-client privilege. Your responses will only be used for preparing your estate planning documents and will be securely maintained.

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Client Information

First Name

Last Name

Middle Name / Initial

Suffix (Jr., Sr., III, etc.)

Date of Birth

Citizenship Status

Street Address

City

State

ZIP Code

Phone Number

Email Address

Occupation

Employer

Marital Status

Prior Marriages?

Please explain (dates, names, how ended, any obligations):

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Children & Dependents

Important: Please list ALL children, including adult children, minor children, stepchildren, and any legally adopted children. Include children from prior relationships.

Full Name	Date of Birth	Relationship	Address (if adult)	Special Needs?	Action

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Retirement Accounts

Institution	Account Type	Owner	Balance	Beneficiary	Action

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Life Insurance Policies

Company	Type	Insured	Death Benefit	Beneficiary	Action

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Business Interests

Do you own any business interests?

Business Name

Ownership %

Approximate Value

Succession Plan or Buy-Sell Agreement?

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Other Assets

Vehicles, Jewelry, Art, Collectibles, Cryptocurrency, etc.

Please list any other valuable assets:

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Liabilities

Mortgages, Loans, Credit Cards, Other Debts

Please list any significant debts or obligations:

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Beneficiaries & Distribution

Primary Beneficiaries (names and % shares)

Contingent Beneficiaries (if primary cannot inherit)

Specific Gifts

Charitable Gifts

At what age(s) should beneficiaries receive their inheritance?

Distribution timing details:

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Fiduciary Appointments

Role	Primary	Alternate	Relationship
Executor
Trustee
Healthcare Agent
Financial Agent
Guardian (minors)

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Health Care & End-of-Life Wishes

Life-sustaining treatment preferences:

Organ donation:

If specific organs, which ones?

Funeral or burial preferences:

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Existing Documents

Do you currently have:

Will

Trust

Health Care POA

Financial POA

None

When created?

Where stored?

Why are you updating now?

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Additional Notes

Anything else we should know?

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Professional Contacts

CPA / Accountant

Contact

Financial Advisor

Contact

How did you hear about us?

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Authorization & Signature

Certification: I certify that the information provided is true and accurate to the best of my knowledge. I understand this information will be used to prepare estate planning documents and is confidential and protected by attorney-client privilege.

Client Signature

Date

📧 Next Steps:

After completing this questionnaire, please save it as a PDF using the "Print / Save as PDF" button above.

Current Clients: After completing your intake form, download the document as a PDF and either email it to Melenni or upload it securely to the Clio portal.

New Clients: Schedule a free consultation to discuss your estate planning needs. An attorney-client relationship is only created after you schedule a consultation and sign an engagement agreement.

Note: Completion of this form does not, by itself, create an attorney-client relationship. You must schedule a consultation and execute an engagement agreement to establish that relationship.