Location of your birth certificate:
Nickname or Preferred Name: Birth Date: Social Security Number: Location of your Social Security Card: Any occupational licenses you have, date licensed, date it expires & where is the original certificate (or proof): Occupation: Estimated Annual Income from Salary, Bonuses, Etc.: Estimated Annual Investment Income (Dividends, Interest, Etc.): Name & Address of Your employer: Name, title & phone number of your immediate superior: Work Telephone: Work Fax: Mobile/Pager: Email Address & password: Home Address (Include County): Home Telephone: Home Fax: Date and Place of Marriage: Location of marriage license: If you have lived outside Texas during this marriage, please list the states and dates of residence: If either of you were previously married, list the dates of prior marriage, name or prior spouse, names of living children from prior marriage(s), and state whether marriage ended by death or divorce (and the location of the divorce or annulment): Location of all annulment or divorce paperwork. Describe any real estate owned by either or both of you outside Texas: Location of Safe Deposit Box (if any): Location of the Key: Name and Telephone of Your Insurance Agent (if any): Name and Telephone of Your Accountant (if any): Name and Telephone of Your Broker or Financial Planner (if any): Other Information: Children - List their full names, date of birth, sex & their current address/phone numbers. Grandchildren - List their full names, date of birth, sex & their current address/phone numbers. Assets (things of value - cash, antiques, real estate, investments) Description Current Fair Market Value How Is Title Held? Where are the original of all the documents? Bank Accounts (not IRAs and Retirement Plans) Stocks, Bonds and Mutual Funds (not IRAs and Retirement Plans) Closely Held Businesses, Partnerships Real Estate Automobiles, Boats, Etc. Other Property Total If you know if the property is your separate property, your wife's separate property or community property, so state. If not, state the name(s) which appear on the title, if known, and state whether the property is held with right of survivorship, if known. Liabilities (debts) Description Amount Mortgages Other Liabilities Are there any outstanding legal judgments against you? Total Life Insurance and Annuities Company Insured Beneficiary(s) Face Amount Cash Value Location of all policies? Are there any outstanding loans against any of these policies? Total IRAs, 401(k)s, and Other Retirement Plans Company/Custodian Participant Type of Plan Vested Amount Death Benefit Total Dispositive Plan: (Describe in general terms how you wish to leave your property at death) Other Beneficiaries (Information about persons other than your spouse and descendants who you wish to benefit.) Full Name Age Address Relationship to You Fiduciaries List name, address, home telephone and relationship to you for each person) Executor: (The executor is the person responsible for probating the will, filing the estate tax return, and distributing assets to beneficiaries.) First Alternate Executor: Second Alternate Executor: Trustee: (The trustee is the person responsible for long-term management of property for the surviving spouse, children, or other beneficiaries.) First Alternate Trustee: Second Alternate Trustee: Guardian of Minor Children: (The guardian is the person who will take physical care of minor children should both parents die.) First Alternate Guardian: Second Alternate Guardian: Property Agent: (The property agent is the person who will handle your financial affairs if you become incapacitated.) First Alternate Property Agent: Second Alternate Property Agent: Health Care Agent: (The health care agent is the person who will make medical decisions for you if you become incapacitated.) First Alternate Health Care Agent: Second Alternate Health Care Agent: DO YOU HAVE THE FOLLOWING LEGAL DOCUMENTS: IF NOT -- YOU NEED THEM -- ESPECIALLY IF YOU ARE SINGLE - EITHER WIDOWED OR NOT LEGALLY MARRIED IN THE EYES OF THE LAW. 1. Last Will & Testiment 2. Statutory Durable Power of Attorney for Financial Decisions 3. Designation of Guardian in the Event of Later Incapacity 4. Living Will (Directive to Physician) & Family Or Surrogates 5. Agent to Control Disposition of Remains upon your Death 6. Medical Power of Attorney (in case you are unable to speak for yourself & tell the doctor what you want done) 7. Do not Resusitate Order
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