Please complete this questionnaire at least three days prior to your Family Wealth Planning Session. All information is strictly confidential.
We must have this Inventory & Assessment completed at least three days prior to your Family Wealth Planning Session, so we have enough time to understand the specifics of your situation prior to our meeting.
If you are married or life partners, please complete sections for both Client 1 and Client 2. If you are single, please complete sections for Client 1 only.
Don't worry about total accuracy. Just do the best you can. All information provided is strictly confidential. If you have questions or need help with any part of this form, please call our office at (541) 632-4313.
Tell us about you, your age, marital status, where you live, and how best to contact you.
Rate the following objectives so we can focus our conversation on the issues most important to you.
Scale: 5 = Critical · 4 = Very Important · 3 = Important · 2 = Slightly Important · 1 = Unimportant · N/A = Inapplicable. Leave blank any item you do not wish to rank.
| Concern | Client 1 | Client 2 |
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| Objective | Client 1 | Client 2 |
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| Concern | Client 1 | Client 2 |
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| Goal | Client 1 | Client 2 |
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| Value | Client 1 | Client 2 |
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Determining the ownership, value, and character of your assets is essential to your plan. Don't worry about total accuracy — just do the best you can.
Character codes: CP = Community Property · CL1 = Separate Property of Client 1 · CL2 = Separate Property of Client 2.
Title codes: JT = Joint Tenancy · TIC = Tenants in Common · ? = Unknown.
| Description / Address | Character | Title | Market Value | Loan Balance |
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| Description | Character | Title | Market Value |
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| Description | Character | Title | Market Value | Loan Balance |
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| Financial Institution | Type | Account # | Character | Title | Amount |
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| Financial Institution | Type | Account # | Character | Title | Amount |
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| Insurance Company | Type | Face Amount | Whose Life Insured | Owner | Beneficiaries | Premium Paid By | Agent |
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| Plan Name | Type | Current Value | Other Information |
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| Business Name | Type | Who Holds Interest | Your Ownership % | Estimated Value |
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| Name of Debtor | Date of Note | Maturity Date | Owed To | Current Balance |
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| Type | Owner | Value |
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Your advisors play a key role in implementing your estate plan — we may need to contact them to confirm beneficiary designations and title changes.
| Type of Advisor | Name | Telephone |
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Listing a person or organization here is not a firm indication of your decision to provide for them — it simply identifies potential beneficiaries for our discussion.
| Full Legal Name | DOB | % of Inheritance | Relationship | Special Needs? | Address & Phone |
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| Full Legal Name | DOB | % of Inheritance | Relationship | Special Needs? | Address & Phone |
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| Organization Name | Address & Phone |
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Identify the people you would trust to act on your behalf as trustees, executors, financial agents, health-care agents, and guardians.
For each nomination please include: name · relationship · address · phone number.
If any of these documents apply to you, please upload them here. PDF, Word, or image files are all welcome (10 MB max per file).
A summary of your responses appears below. Review carefully, sign the affirmation, and click Submit.
🔒 Secure form — your information is encrypted in transit and protected.
We've received your Family Wealth Inventory & Assessment.
Patrick will review your responses prior to your Family Wealth Planning Session. If we need any clarification, we will reach out by phone or email.
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